Sepsis-Induced Takotsubo Cardiomyopathy Leading to Torsades de Pointes

Background. Takotsubo cardiomyopathy (TCM) is sudden and reversible myocardial dysfunction often attributable to physical or emotional triggers.Case Report. We describe a 51-year-old man presented to emergency department with sepsis from urinary tract infection (UTI). He was placed on cefepime for UTI and non-ST-elevation myocardial infarction protocol given elevated troponins with chest pain. Subsequently, patient was pulseless with torsades de pointes (TdP) and then converted to sinus rhythm with cardioversion. An echocardiogram revealed low ejection fraction with hypokinesis of the apical wall. Over 48 hours, the patient was extubated and stable on 3 L/min nasal cannula. He underwent a cardiac catheterization to evaluate coronary artery disease (CAD) and was found to have mild nonobstructive CAD with no further findings.Conclusion. TCM is a rare disorder presenting with symptoms similar to acute coronary syndrome. Though traditionally elicited by physical and emotional triggers leading to transient left ventricular dysfunction, our case suggests that it may also be triggered by a urinary tract infection and lead to severe QT prolongation and a malignant ventricular arrhythmia in TdP.

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Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

Current Cardiology Reviews ◽

10.2174/1573403x15666191120114442 ◽

2020 ◽

Vol 16 (3) ◽

pp. 241-246

Author(s):

Dipesh Ludhwani ◽

Belaal Sheikh ◽

Vasu K Patel ◽

Khushali Jhaveri ◽

Mohammad Kizilbash ◽

...

Keyword(s):

Case Report ◽

Takotsubo Cardiomyopathy ◽

Systolic Dysfunction ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

Coronary Syndrome ◽

Normal Left Ventricular ◽

Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

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Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215116008288 ◽

2016 ◽

Vol 130 (9) ◽

pp. 883-886 ◽

Cited By ~ 4

Author(s):

F Keshtkar ◽

O T Dale ◽

W O Bennett ◽

C E Hall

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Takotsubo Cardiomyopathy ◽

Apical Ballooning ◽

Left Ventricular ◽

Coronary Syndrome ◽

Wave Inversion ◽

Acute Airway Obstruction ◽

Artery Disease ◽

High Index Of Suspicion

AbstractBackground:Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.Case report:A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.Conclusion:Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.

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Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040566 ◽

2019 ◽

Vol 16 (4) ◽

pp. 566

Author(s):

Wei-Yi Shih ◽

Chia-Chen Chang ◽

Meng-Ting Tsou ◽

Hsin-Lung Chan ◽

Ying-Ju Chen ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Home Care ◽

Urinary Catheter ◽

Antibiotic Prescription ◽

Artery Disease ◽

Underlying Diseases ◽

Common Infection

Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.

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B-Type natriuretic peptide levels predict extent and severity of coronary artery disease in non-ST elevation acute coronary syndrome and normal left ventricular function

Indian Heart Journal ◽

10.1016/j.ihj.2013.12.015 ◽

2014 ◽

Vol 66 (2) ◽

pp. 183-187 ◽

Cited By ~ 6

Author(s):

Brij Mohan Goyal ◽

S.M. Sharma ◽

Mohit Walia

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Left Ventricular Function ◽

Left Ventricular ◽

Normal Left Ventricular Function ◽

Coronary Syndrome ◽

Normal Left Ventricular ◽

St Elevation ◽

Artery Disease

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Recurrent Direct Current Cardioversion Induced Takotsubo Cardiomyopathy

International Cardiovascular Forum Journal ◽

10.17987/icfj.v3i0.94 ◽

2015 ◽

Vol 3 ◽

pp. 32

Author(s):

Athanasios Smyrlis ◽

Dmitry Yaranov ◽

Ira Galin ◽

Shahzad Khan ◽

Jonathan Alexander

Keyword(s):

Direct Current ◽

Takotsubo Cardiomyopathy ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Stress Cardiomyopathy ◽

Direct Current Cardioversion ◽

Catecholamine Excess ◽

Artery Disease

<p>Stress cardiomyopathy (SCM), also called broken heart syndrome and Takotsubo cardiomyopathy is an increasingly reported syndrome generally characterized by transient systolic dysfunction of the apical and or mid segments of the left ventricle that mimics myocardial infarction, in the absence of obstructive coronary artery disease. Typically patients present within a few hours of exposure to physical or emotional stress. However, the mechanism by which these stressors result in myocardial dysfunction is unclear. Proposed factors include catecholamine excess and coronary vasospasm<sup>1</sup>. We present the case of a 61-year-old female who experienced acute pulmonary edema secondary to stress cardiomyopathy, on two occasions immediately after undergoing elective direct current cardioversion (DCCV) for atrial fibrillation (Afib). After an urgent hospitalization for management of acute left ventricular failure, she made a complete clinical and echocardiographic recovery. The incidence, clinical implications and prognosis of DCCV induced SCM is unknown. Given DCCV for Afib is a common outpatient procedure and DCCV induced SCM can lead to acute clinical deterioration it is important that physicians are vigilant about this newly recognized electrical cardioversion complication.</p>

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Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

Case Reports in Medicine ◽

10.1155/2010/467867 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Oliver Koeth ◽

Uwe Zeymer ◽

Rudolf Schiele ◽

Ralf Zahn

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Takotsubo Cardiomyopathy ◽

Clinical Symptoms ◽

Significant Coronary Artery Disease ◽

Apical Ballooning ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Artery Disease

Takotsubo cardiomyopathy (TCM) is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI) is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM.

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