P312 TAKOTSUBO SYNDROME DURING INFECTIVE ENDOCARDITIS: AN UNUSUAL COMBINATION

Abstract

Abstract A 66–year–old woman presented to medical attention for low back pain, weight loss and evening fever for about 2 weeks, with concomitant mood deflection. Blood cultures were positive for Streptococcus mutans. Lumbar spondylodiscitis was found on spinal MRI and splenic infarction on abdominal ultrasound. The echocardiogram revealed the presence of vegetations on the aortic valve, which was severely regurgitant, and on the tricuspid valve, which was moderately regurgitant, in a setting of preserved biventricular dimensions and function. The patient was diagnosed with infective endocarditis, complicated by systemic embolization. The hospital stay was complicated, despite the appropriate antibiotic therapy, with acute pulmonary edema and cardiogenic shock, with a sudden worsening of the left ventricular function which became severely reduced, in the presence of an "apical ballooning" appearance. Anterior T–wave inversion with prolongation of the QT interval was documented on the electrocardiogram. Coronary lesions were excluded by coronary CT scan. According to the InterTAK criteria, the patient achieved a score of 80, suggestive of a high probability of Takotsubo syndrome. In the following days, thanks to continuous infusion of diuretics and inotropic support, a hemodynamic compensation was obtained; there was a progressive recovery of the left ventricular function and of the apical wall motion abnormalities, with suspension of the inotropic support and reduction of the dosage of the diuretic. We concluded for Takotsubo syndrome in the setting of acute infective endocarditis. The patient, with a stabilized clinical picture, finally underwent cardiac surgery to replace the aortic and tricuspid valves without complications. Takotsubo syndrome (TS) is a condition characterized by a transient impairment of left ventricular function and kinetics, typically triggered by physical or emotional stress. In the literature only four cases of concomitant endocarditis and TS are reported, in which other triggers are recognizable (recent surgery, cerebral involvement with embolization or meningitis). In our case, there are no other apparent triggers other than endocarditis. Endocarditis could therefore represent in itself a new trigger for TS or even manifest, from the beginning, with a TS.