Takotsubo cardiomyopathy in a patient with dengue fever

Abstract

Takotsubo cardiomyopathy is referred to a transient, stressinduced cardiomyopathy, or a transient left ventricular apical ballooning syndrome. Its postulated pathogenesis includes excess secretion of catecholamine, coronary artery spasm, or focal myocarditis. It may occur after surgery or acute medical condition such as acute emotional stress or septicemia. Association with acute dengue virus infection was rarely reported in the literature. A 72-year-old woman with hypertension and diabetes mellitus suffered from general malaise and poor appetite in recent days. She experienced cold sweating and then had an attack of syncope in the morning of admission on August 5, 2015. She denied having fever, chest tightness, productive cough, or tarry stool passage. Her electrocardiogram showed sinus bradycardia, inverted T wave changes (V3eV6), and prolonged QT interval (QTcZ 597 milliseconds; Figure 1A). Elevated cardiac enzymes including total creatine kinase, 312e341 IU/L (normal, 29e168 IU/L); creatine kinase MB form, 13.0e18.4 ng/mL (normal, <5.1 ng/mL); and hs-troponin I, 7848.8e8499.3 pg/mL (normal, <26.2 pg/mL) were noted. Non-ST-elevated acute myocardial infarction (NSTEMI) was impressed. Initially, dual antiplatelet agents (aspirin and ticagrelor) were given. However, laboratory data of blood obtained before the antiplatelet therapy revealed the following: