Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report

Context: The Takotsubo cardiomyopathy (TTC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia, more common in postmenopausal women and related to emotional stress. Case report: A 71-year-old female patient, with Alzheimer’s disease (AD), sought emergency care after severe chest pain. Electrocardiogram showed ST segment elevation in the anteroseptal wall. Physical exam: HR=108bpm, PA=126x78mmHg, SaO2=6%. Complementary exams showed a mild lesion in the middle third of the anterior descending artery, moderate impairment of left ventricular (LV) function by apical aneurysm without thrombi, mitral prolapse with mild reflux and an ejection fraction of 37%, suspecting of TTC. Conclusions: TTC is defined as a transient, usually reversible and segmental LV dysfunction, configuring a differential diagnosis of acute coronary syndrome. An overactivation of the sympathetic autonomic nervous system can cause catecholamine toxicity to the heart. Although several studies show a lower emotional response capacity in patients with cognitive impairment, more recent studies suggest that this emotional responsiveness is not so affected by dementia. Therefore, patients with AD may be susceptible to developing TTC, both because of the multiple drugs that they are exposed, increasing catecholamine levels, and because of the disease itself, that represents a stressful context. Thus, TTC is often associated with emotional stress and should not be overlooked in patients with AD.

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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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