Ampulla Cardiomyopathy Research Articles

Pharmacological Triggers of Takotsubo Cardiomyopathy: An Updated Review of Evidence and Recommendations.

Previous publications in 2011, 2016, and 2022 have presented lists of drugs associated with takotsubo cardiomyopathy (TCM). This review aims to provide updated drug lists that have been reported as potential causes of TCM. Following the same methodology employed in previous reviews, a detailed investigation was carried out in the PubMed/Medline database from June 2022 to July 2023 to identify drug-induced TCM (DITC) case reports. Various search terms related to the drug-induced transient left ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, drug-induced broken heart syndrome, drug triggered takotsubo cardiomyopathy, takotsubo cardiomyopathy, and iatrogenic takotsubo cardiomyopathy were utilized. Filters for fulltext availability, case reports, human studies, and English language were applied. Articles reporting drugs associated with TCM development were included in the analysis. Foremost 192 case reports were initially identified, with 75 drugs meeting the inclusion criteria after a thorough review. The latest revision identified seven drugs that might lead to TCM, with four drugs (57.14%) already reported in previous reviews and three drugs (42.86%) newly identified. Consequently, the updated drug list potentially triggering TCM in 2023 comprises a sum of 75 drugs. The recent 75 drugs provided additional evidence linking to TCM development. The updated list predominantly includes drugs that induce sympathetic overstimulation, although some drugs on the list have unclear associations with sympathetic nervous system activation.

Our Clinical Experience and Case Series of Takotsubo Cardiomyopathy

Objective
 In this study we aimed to evaluate the clinical course and prognosis of Takotsubo Cardiomyopathy cases diagnosed and treated in our clinic.
 Cases
 Takotsubo Cardiomyopathy was first described in 1990 by Hikaru Sato et al. The reason why it is called Tako-tsubo cardiomyopathy; This is due to the appearance of the left ventricle resembling the narrow-necked, broad-bottomed container used by Japanese fishermen to catch octopuses. In addition to Takotsubo cardiomyopathy, this syndrome is also called ampulla cardiomyopathy, Human stress cardiomyopathy and Broken heart syndrome. In this study, a series of 7 cases of Takotsubo Cardiomyopathy diagnosed and treated in our clinic are presented and the clinical course and prognosis of the disease are examined.
 Results
 The age range of the series, consisting of six female and one male patients, ranged from 57 to 81 years (median age 70). All of the female patients were in the postmenopausal period and physical or emotional stress was found in four of them. Moderate-to-moderate cardiac enzyme elevation was found in all of the patients. While noncritical plaques were detected in the angiography of six patients who underwent coronary angiography and ventriculography, one patient had normal coronaries. During the follow-up, in-hospital death due to non-cardiac causes (Acute Myeloblastic Leukemia) was observed in one of the patients. In the echocardiographic follow-up of six surviving patients, it was observed that the LV ejection fraction was normalized and ballooning regressed within two months.
 Conclusion
 The awareness of Takotsubo Cardiomyopathy among cardiology physicians in the world and in our country is increasing. However, information about its prevalence, clinical course and short-term prognosis in our country is insufficient. In the study, a new series was presented in addition to the first data of our country. It is thought that there may be some different physical risk factors that have not yet been identified.

Miocardiopatía de takotsubo desencadenada por la utilización o exposición a drogas de abuso, sustancias químicas o venenos de origen animal

MotivationTo identify drugs of abuse, chemical substances or animal poisons associated to takotsubo cardiomyopathy. MethodsStructured review of Pubmed/Medline, where the following search terms were used: Takotsubo cardiomyopathy, Tako-tsubo cardiomyopathy, stress cardiomyopathy, transient-left-ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, OR broken heart syndrome; together with “drugs abuse”, “chemistry substance.” “iatrogenic”, “drug-induced” OR “induced by”. Articles in English, French or Spanish published between January 1st 1990 and October 31st 2015 and with access to the full text were selected. Articles reporting drugs of abuse, chemical substances or animal poisons as possible triggers of this cardiomyopathy were included. Additionally, references of those selected articles were included, valued as relevant. Results852 different articles were found, 23 were selected as well as 4 relevant references, where 38 takotsubo cardiomyopathy were identified, possibly associated to the use or exposure to drugs of abuse, chemical substances or animal poisons, especially carbon monoxide (n=13; 34.2%), cocaine or crack (n=5, 13.2%), alcohol withdrawal (n=5; 13.2%), animal poison (n=5; 13.2%) and amphetamines (n=4; 10.5%). Overall 14 different substances were identified as possible triggers of this cardiomyopathy. ConclusionTakotsubo cardiomyopathy could be triggered by the use or exposure to 14 drugs of abuse, chemical substances or animal poisons, which in most cases generate a sympathetic overstimulation. Thus it is recommended to consider this type of situation in patients presenting this kind of cardiomyopathy, especially in those where a physical or emotional trigger cannot be identified.

Drugs as Possible Triggers of Takotsubo Cardiomyopathy: A Comprehensive Literature Search - Update 2015.

In 2011 a list of 20 drugs linked to drug-induced Tako-Tsubo cardiomyopathy (TCM) was published. Thus, the objectives were both to identify cases of drug-induced TCM, and update the 2011 list of drugs as possible triggers of this cardiomyopathy. As the 2011 report of drug-induced TCM, case reports of drug-induced TCM were identified by a comprehensive search in Medline/PubMed database. From December 2010 to March 2015 search terms were Takotsubo cardiomyopathy, Takotsubo cardiomyopathy, stress cardiomyopathy, transient-left-ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, OR broken heart syndrome; together with "iatrogenic", "drug-induced", OR "induced by". Publications limited to English, Spanish, and French, in humans, and with full texts were retrieved. Articles that recognized any drug as a possible trigger of TCM were selected. Overall, 405 different references were retrieved and 67 were selected (62 case reports and 5 case series) involving 78 patient cases with TCM possibly associated to drugs were reviewed. At total of 44 drugs were recognized as possible drug-induced TCM, mainly with sympathetic effect, and 37 (84.1%) were different to those 20 identified in the 2011 review; therefore, a list of 57 drugs associated to TCM was obtained. There are new case reports that linked drug-use with the development of TCM. The list of 57 drugs obtained is principally integrated by drugs that generate sympathetic overstimulation. Consequently, the recommendation "drug-induced TCM would be considered in patients with TCM, particularly those in which no clear emotional or stress trigger could be identified" is endorsed.

The ATAK complex (Adrenaline, Takotsubo, Anaphylaxis, and Kounis hypersensitivity -associated coronary syndrome) in neurological conditions.

Sir, Takotsubo syndrome, transient left ventricular apical ballooning, takotsubo cardiomyopathy, apical ballooning syndrome, atypical apical ballooning, ampulla cardiomyopathy, broken heart syndrome, transient left ventricular dysfunction syndrome, and stress cardiomyopathy were named after a round-bottomed and narrow-necked fishing pot - takotsubo in Japanese - for trapping octopus because of its resemblance to left ventriculogram. In the interesting report published in Indian Journal of Critical Care Medicine,[1] a 48-year-old man with progressive loss of vision, hypotension, tachycardia, and acidosis was found to have takotsubo syndrome while the coronary arteries were normal. Computerized tomography revealed dense sellar-suprasellar mass lesion extending into the hypothalamus resembling pituitary adenoma with hypocortisolism suggesting hypopituitarism. With dobutamine, atenolol, and noradrenaline, his condition improved. This case raises some issues concerning neurological conditions, mental stress adrenaline, anaphylaxis, and Kounis syndrome. Mental stress commences with impulses from high brain cortical centers that are relayed through the limbic system to hypothalamus resulting in the release of corticotropin-releasing hormone (main coordinator of the mental stress response) and norepinephrine, serotonin, acetylcholine, proopiomelanocortin, adrenocorticotropic hormone, glucagon, growth hormone, and homocysteine that stimulate sympathetic nervous system. These substances can induce heightened cardiovascular activity, endothelial injury, induction of adhesion molecules on the endothelial cells, to which recruited inflammatory cells adhere and translocate to the arterial wall and finally myocardial damage. An acute phase response is engendered, resulting in production of cytokines interleukin-1 (IL-1), IL-6, tumor necrosis factor-alpha, acute phase proteins, macrophage, mast cell, and platelet activation that eventually culminate in the development of Kounis syndrome.[2] Stress-induced cytokine production has been incriminated for multivessel coronary artery spasm at epicardial or microvascular levels that induce takotsubo cardiomyopathy. Inflammatory mediators released during anaphylaxis can induce coronary spasm and takotsubo syndrome and adrenaline given for anaphylaxis might contribute to coronary spasm and transient takotsubo syndrome. Adrenaline and noradrenaline released by the renin-angiotensin-aldosterone system together with histamine stimulate the release of more catecholamines by direct action on the adrenal medullary cells. Administration of catecholamines for hemodynamic support of anaphylactic shock would also increase the plasma catecholamines. Catecholamine increase in patients with angina, renders blood platelets more sensitive and more prone to aggregation and thrombosis. Therefore, measurement of anaphylactic inflammatory mediators including histamine, chymase, leukotrienes, thromboxane, and platelet activating factor or the use of corticosteroids or mast cell stabilizers for prevention and treatment may shed light on etiology and pathophysiology of takotsubo cardiomyopathy. The concurrence of acute coronary syndromes with conditions associated with mast cell activation, involving interrelated and interacting inflammatory cells constitute the Kounis syndrome.[3] Inflammatory cells, such as mast cells, T-cells, and macrophages, activate each other via multidirectional stimuli and release mediators capable to induce coronary events. Experimental findings suggest that cardiac mast cell activation by acute stress may contribute to myocardial ischemia through the release of histamine or proinflammatory mediators.[4] Therefore, takotsubo cardiomyopathy should be always considered in neurological conditions with prolonged addisonian crisis. Furthermore, Adrenaline, takotsubo, Anaphylaxis, and Kounis syndrome (ATAK) seem to constitute a challenging contemporary complex that needs inexorable “attack” to elucidate its etiology, pathophysiology, and treatment.[5] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest

Attack the ATAK : “οὓς ὁ θεὸς συνέζευξε, ἄνθρωπος μὴ χωριζέτω” (ous o theos synezeuxe anthropos me horizeto) “what therefore God hath joined together, let not man put asunder”

“Voodoo Death”was the title of a paper published, more than half a century ago [1], by the renowned American physiologist Walter B. Cannon and was based on anecdotal experiences, largely from the anthropology literature, dealing with death from fright. “Voodoo” is of African origin and concerns superstitious beliefs and practices found among Negroes of West Indies and Southern United States. Canon was the first to postulate that death from fright is caused by a lasting and intense action of sympathico-adrenal system. Phrases such as “scared to death” and “a broken heart”, are still used today and are deeply rooted in folk wisdom and reflect potentially lethal consequences of emotional, depressogenic or mental stress. Indeed, terms such as broken heart syndrome, transient left ventricular apical ballooning, stress-induced cardiomyopathy, apical ballooning syndrome, atypical apical ballooning, ampulla cardiomyopathy or transient left ventricular dysfunction syndrome characterize the takotsubo syndrome that usually follows emotional distress. This clinical entity has been excessively discussed nowadays but there are many questions regarding its etiology, pathophysiology and treatment which still remain unanswered. It has been emphasized recently [2] that adrenaline, takotsubo, anaphylaxis, and Kounis syndrome (ATAK) constitute a challenging contemporary complex that needs “attacking” in order to elucidate its etiology and pathophysiology and apply the proper preventive and therapeutic measures.

A case of adrenal crisis caused by isolated adrenal metastasis presenting with ampulla cardiomyopathy

A case of adrenal crisis caused by isolated adrenal metastasis presenting with ampulla cardiomyopathy

Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: A systematic review.

To investigate the possible association between Tako-tsubo cardiomyopathy (TTC)-a reversible clinical condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mechanisms- and respiratory system diseases. We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to articles in English. The search keywords were: "tako-tsubo cardiomyopathy", "takotsubo", "takotsubo cardiomyopathy", "broken heart syndrome", "stress-induced cardiomyopathy", "apical ballooning syndrome", and "ampulla cardiomyopathy in combination with respiratory diseases, lung, pulmonary disease. For each kind of disease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome. Out of a total of 1725 articles found, we selected 37 papers reporting a total of 38 patients. As expected, most patients were women (81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged uneventfully in a few days. An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.

症例 複数回の再発と異なる壁運動異常を呈した,たこっぼ型心筋症の1例

症例 複数回の再発と異なる壁運動異常を呈した,たこっぼ型心筋症の1例

左室内血栓を有し, たこつぼ様壁運動の遷延を認め, 難治性心室頻拍が生じた1例

左室内血栓を有し, たこつぼ様壁運動の遷延を認め, 難治性心室頻拍が生じた1例

Broken Heart Syndrome (Takotsubo Cardiomyopathy) Triggered by Acute Mania: A Review and Case Report

Throughout the centuries and in various cultures, authors have described a relationship between emotional states and heart functioning, colloquially called a “broken heart.” Similarly, the medical literature is filled with reports of stress-induced cardiac disorders, including sudden cardiac death. Initially called “human stress cardiomyopathy syndrome,” the phenomenon was first described by doctors reporting “extensive myocardial contraction band necrosis” found in a series of murder victims who had been emotionally and physically traumatized prior to their deaths. Pathology reports described the myocardial damage to have been “comparable to lesions described in stressed animal experiments” and suggested that their findings were “strongly supportive of the theory of catecholamine mediation of these myocardial changes in man and of the lethal potential of stress through its effect on the heart.” Over the years, the medical nomenclature has changed and the condition has been called by many names, including “broken heart syndrome,” “human stress cardiomyopathy syndrome,” “left ventricular apical ballooning syndrome,” “ampulla cardiomyopathy,” “transient left ventricular dysfunction,” “transient left ventricular (LV) apical ballooning syndrome,” “stress cardiomyopathy,” “apical ballooning syndrome,” and finally “Takotsubo cardiomyopathy.” The name Takotsubo cardiomyopathy (TTC) was first used in the Japanese medical literature to describe the appearance on left ventriculography, which reveals a rounded hypokinetic apex with a narrow hypercontracted base resembling a pot previously used in Japan to catch octopus (in Japanese “tako” means octopus and “tsubo” means pot). TTC is a cardiac syndrome characterized by transient LV dysfunction (typically in the above pattern), electrocardiographic changes that can mimic acute myocardial infarction (MI), and a low-level release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD).

Torsades de Pointes in an Elderly Patient with “Broken Heart Syndrome”

Broken heart syndrome, also called transient left ventricular apical ballooning syndrome (TLVABS), is described as an acute cardiomyopathy characterized by acute, but rapidly reversible, left ventricle systolic dysfunction in the absence of atherosclerotic coronary artery disease which appears to be triggered by intense psychological and physical stress. The syndrome is also named takotsubo syndrome, ampulla cardiomyopathy, or stress-induced cardiomyopathy. We report a woman aged 75 years with dyspnea, ST-segment elevation in the precordial leads, elevation of cardiac enzymes, and normal coronary arteriography. Transient apical systolic left ventricular dysfunction and pneumonia were suspected. Gradual prolongation of QT interval and torsades de pointes (TdP) subsequently occurred. Patients had a complete recovery of cardiac function, normalization of QT interval, and normal apical cardiac wall motion in a few days after lidocaine pump and empiric antibiotics use. Since TdP is rarely reported with TLVABS, we should pay more attention to postmenopausal women with chest pain and elevated cardiac enzymes. We should keep TLVABS in mind and use convenient tools, such as bedside echocardiography, for diagnosis.

Stress-Induced Cardiomyopathy Presenting as Ventricular Tachycardia

Stress-Induced Cardiomyopathy Presenting as Ventricular Tachycardia

A Unique Case Of Recurrent Takotsubo Cardiomyopathy- Atypical Followed By Typical Variant.

Takotsubo cardiomyopathy (TC), synonymous with apical ballooning syndrome, broken heart syndrome, stress induced/ ampulla cardiomyopathy is characterized by transient left ventricular dysfunction of apical ( typical) or mid segments (atypical), mimicking acute myocardial infarction in the absence of significant coronary artery disease . We report a rare case of recurrent takotsubo cardiomyopathy in which the first and second presentations were atypical and typical variants respectively. We performed a literature search regarding takotsubo cardiomyopathy with emphasis on incidence and recurrence especially if one type was followed by other.

Transient Cardiac Failure Due to Takotsubo Cardiomyopathy After Surgical Reduction of Nasal Fracture

Takotsubo syndrome, also known as ampulla cardiomyopathy, broken heart syndrome, idiopathic apical ballooning syndrome, and stress-induced myocardial stunning, has been first described by Japanese authors in 1996 and subsequently specified in 2001; it derives from the resemblance between the ancient round-bottomed, narrow-necked Japanese fishing pots used to trap octopus in Asia and the end-systolic appearance of the left ventricle on ventriculography. We introduce the case of a woman who was involved in a traffic car crash and, subsequently, was admitted to the Maxillo-Facial Unit of the Novara Major Hospital with a diagnosis of nasal fracture. She underwent general anesthesia for the reduction of the fracture; after surgery, she developed acute chest pain, elevated cardiac biomarkers, ischemic electrocardiogram changes, and transient akinesis of the left ventricle without significant epicardial coronary artery disease. A diagnosis of takotsubo syndrome was made. This syndrome, which presents the same clinical features of a ventricular failure, is probably underdiagnosed, but after the introduction of sophisticated cardiac imaging and coronary intervention, more cases are identified and an unnecessary thrombolytic therapy can be spared. This reversible condition, which is, to our knowledge, never mentioned after a craniomaxillofacial surgical procedure, should be considered in the diagnostic algorithm for all patients presenting with acute onset of chest pain, elevated cardiac biomarkers, and ischemic changes on the electrocardiogram after a general anesthesia.

A Comprehensive Literature Search: Drugs as Possible Triggers of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a syndrome of transient cardiac dysfunction precipitated by intense emotional or physical stress. Excessive sympathetic stimulation is believed to be central to the pathogenesis of this condition, thus drugs with sympathetic effect could precipitate TCM. The aim of this study was to conduct a comprehensive literature search to identify drugs that could precipitate TCM. Published case reports of TCM associated with drug-used were identified by a comprehensive literature search using the Medline/PubMed database, from January 1990 to November 2010. Search terms included Takotsubo cardiomyopathy, Tako-tsubo cardiomyopathy, stress cardiomyopathy, transient-left-ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, OR broken heart syndrome; together with "iatrogenic", "drug-induced", OR "induced by". Only publications in English or Spanish, in Humans, and with links to full text were retrieved. Then, articles that recognized any drug as a possible drug-induced TCM were selected. Additionally, citation lists from identified articles were subsequently reviewed to identify additional relevant articles. Overall, 401 different references were retrieved and 42 selected. Additionally, 5 articles were identified from citation list of selected articles. Thus, 47 articles with one report of more drugs as a possible trigger of 58 cases of SCM were reviewed, in which 20 different drugs were recognized as possible drug-induced TCM. There are some reports that linked the drug-used, mainly associated to sympathetic overstimulation, with the development of TCM. Consequently, drug-induced TCM would be considered in patients with TCM, particularly those in which no clear emotional or stress trigger could be identified.

Tako-tsubo cardiomyopathy: is there a preferred time of onset?

The occurrence of major cardiovascular events is not randomly distributed over time, but exhibits chronobiological patterns, i.e., circadian, weekly, or seasonal. No systematic studies on the temporal preference of onset of Tako-tsubo cardiomyopathy (TTC) are known. We performed a computer-assisted search of the literature (from 2000 to January 2010), with the following search terms: transient left ventricular apical ballooning syndrome, takotsubo-like left ventricular dysfunction, ampulla cardiomyopathy, tako-tsubo or takotsubo cardiomyopathy, tako-tsubo, apical ballooning. Criteria for publication inclusion were (a) reporting of original data, (b) inclusion of at least 30 or more cases, (c) adherence to the requested diagnostic criteria for TTC. We focused on studies including in their purposes the "time of onset" of events. Out of the 19 studies found, 7 (4 from Europe, 1 each from Asia, Australia and USA) specifically addressed this aspect. A circadian (morning) and a seasonal (summer) higher frequency of events was found. TTC seems to exhibit a temporal variation of onset, with preferred peaks during morning and summer. Stress and catecholamines, also according to their temporal organization, might play a pivotal role. The demonstration of time frames characterized by highest frequency of occurrence might help to try to ensure maximal protection during particularly vulnerable periods.

Takotsubo (Stress) Cardiomyopathy and the Anesthesiologist: Enough Case Reports. Let's Try to Answer Some Specific Questions!

Takotsubo cardiomyopathy (also known as takotsubo syndrome, broken heart syndrome, ampulla cardiomyopathy, transient left ventricular apical ballooning, apical ballooning syndrome, transient left ventricular dysfunction syndrome, and stress [induced] cardiomyopathy) was first described in Japan in 1990. 1 ** It was initially characterized by a unique pattern of transient (hours to weeks) wall motion abnormality (“transient left ventricular apical ballooning”) occurring in the absence of significant epicardial coronary artery disease, presenting as an acute coronary syndrome, most frequently in postmenopausal elderly women, often triggered by stressful situations. It has since been observed throughout the world and under various circumstances.†† This condition was first described in the perioperative period in the North American anesthesia literature via case reports that appeared in the September 2006 issues of Anesthesia & Analgesia 4 and Anesthesiology. 5 Since that time, multiple case reports of periprocedural (e.g., endoscopy, catheterization, and electroconvulsive therapy) and at least 25 to 38 perioperative cases of takotsubo cardiomyopathy have appeared 6–23 with the latest in this issue of Anesthesia & Analgesia. 24,25 Anesthesiologists may also confront this syndrome while caring for patients with aneurysmal subarachnoid hemorrhage (A-SAH), 26–29 pheochromocytoma, 30–37 and other critical illnesses. 3,38,39 In this issue of Anesthesia & Analgesia, Daly and Dixon 24 report on 2 cases of takotsubo cardiomyopathy that occurred in an elderly (76- and 78-year-old) man and woman,

Takotsubo Cardiomyopathy and Canalith Repositioning Procedure for Benign Paroxysmal Positional Vertigo

Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome, ampulla cardiomyopathy, or transient left ventricular dysfunction is characterized by chest pain, electrocardiographic changes, transient left ventricular apical aneurysm, and normal coronary arteries. Takotsubo is a round-bottomed, narrow-necked Japanese octopus trap and lends its name to takotsubo cardiomyopathy because of its resemblance to echocardiographic and ventricular angiographic images of the left ventricle in this condition. This appearance takes its source from peculiar, transient regional systolic dysfunction involving the left ventricular apex and mid-ventricle with hyperkinesis of the basal left ventricular segments. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo caused by peripheral vestibular dysfunction. The symptoms of BPPV are attributed to intralabyrinthine particles, presumed displaced otoconia. Thus, the treatment recommended for BPPV is head repositioning maneuvers. To present the first takotsubo cardiomyopathy case in the English literature related to BPPV undergoing canalith repositioning procedure. This report will provide additional information for physicians encountering acute-onset chest pain and vertigo. It will also expand the spectrum of clinical correlates of the increasingly well recognized but poorly understood syndrome, takotsubo cardiomyopathy.

A case of “ampulla cardiomyopathy (Tako-Tsubo cardiomyopathy)” with severe carbon-monoxide poisoned patient

たこつぼ型心筋症は様々な要因により発症することが知られている。高濃度一酸化炭素暴露後に遅発性のたこつぼ型心筋症を合併し心不全に至った1例を経験したので報告する。症例は42歳，女性。練炭自殺による重症一酸化炭素中毒で搬送された。搬送時，血中carboxyhemoglobin濃度 25.2%と高く，心筋逸脱酵素も上昇していた。心電図，胸部X線では異常を認めなかった。直ちに高気圧酸素療法を施行した。第3病日，突然急性心不全による肺水腫が出現した。心電図では前胸部誘導で陰性T波，II，III，aVF 誘導でST軽度上昇を認めた。心臓超音波検査で冠灌流流域に一致しない心尖部壁運動高度低下とたこつぼ型心筋症に特徴的な心尖部のバルーン状変化を認めた。冠動脈造影CTでは冠動脈病変を認めず，たこつぼ型心筋症による心不全と診断した。第22病日，心機能は改善した。高濃度一酸化炭素暴露による心筋傷害には相対的心筋虚血のみならず，心筋への直接的心毒性によるものが報告されている。本症例では一酸化炭素による心筋傷害に加え，身体的・精神的ストレスが加わったことでたこつぼ型心筋症を発症し心不全に至ったと考えられた。重症一酸化炭素中毒症例では，入院時の心機能障害の有無にかかわらず慎重な循環・呼吸モニタリングが必要と考えられた。