“Nutritional or Hormonal”, The Myth of Takotsubo Cardiomyopathy and Left Ventricular Thrombosis in Anorexia Nervosa Patients! A Case Report

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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Takotsubo Cardiomyopathy Complicated with Left Ventricular Thrombus in Myasthenic Crisis: A Case Report

American Journal of Case Reports ◽

10.12659/ajcr.915415 ◽

2019 ◽

Vol 20 ◽

pp. 743-747 ◽

Cited By ~ 1

Author(s):

Natnicha Pongbangli ◽

Sasivimon Jae-aue ◽

Wanwarang Wongcharoen ◽

Arintaya Phrommintikul

Keyword(s):

Case Report ◽

Takotsubo Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Myasthenic Crisis ◽

Ventricular Thrombus

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Takotsubo cardiomyopathy associated with dydrogesterone use

BMJ Case Reports ◽

10.1136/bcr-2021-246553 ◽

2021 ◽

Vol 14 (11) ◽

pp. e246553

Author(s):

Adam Ioannou

Keyword(s):

Coronary Artery Disease ◽

Case Report ◽

Coronary Artery ◽

Takotsubo Cardiomyopathy ◽

Premenopausal Woman ◽

Apical Ballooning ◽

Left Ventricular ◽

Female Sex Hormones ◽

First Case ◽

Artery Disease

Takotsubo cardiomyopathy is characterised by left ventricular apical ballooning, in the absence of coronary artery disease, and classically occurs at times of intense stress. Due to the striking preponderance of Takotsubo cardiomyopathy occurring in postmenopausal women, it has been postulated that female sex hormones may also be implicated in its pathogenesis. This case report describes the first case of Takotsubo cardiomyopathy associated with the initiation of dydrogesterone (a synthetic retroprogesterone) in a premenopausal woman.

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Reverse takotsubo cardiomyopathy caused by patent foramen ovale-related cryptogenic stroke: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa407 ◽

2020 ◽

Author(s):

Hiroya Takafuji ◽

Junya Arai ◽

Kuniyasu Saigusa ◽

Kotaro Obunai

Keyword(s):

Heart Failure ◽

Case Report ◽

Acute Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Left Ventricular ◽

Heart Team ◽

Foramen Ovale

Abstract Background Reverse takotsubo cardiomyopathy (rTTC) is recognized as an atypical type of TTC. It has been suggested that neurological events are typical trigger of rTTC, especially in young individuals. Case summary In this case report, we describe a 16-year-girl who presented with neurological deficits due to embolic stroke and acute heart failure. Transthoracic echocardiography on admission revealed a severely reduced left ventricular (LV) function with akinesis of basal to mid LV, but normal contraction in apex. Coronary computed tomography angiography confirmed unobstructed coronary arteries. Two weeks later, her LV wall motion and ejection fraction were completely normalized. Transthoracic echocardiography and transoesophageal echocardiography demonstrated no evidence of intracardiac thrombus but showed a patent foramen ovale (PFO) with large shunt. After thorough work-up and brain–heart team discussion, we concluded that the patient developed rTTC due to cryptogenic stroke related with her PFO. She underwent percutaneous PFO closure for secondary prevention with good clinical course. Discussion Reverse TTC is a rare condition. It should be considered in stroke patients with acute heart failure. Quick diagnosis and management with brain–heart team is crucial for better prognosis.

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Takotsubo cardiomyopathy with transient left ventricular obstruction successfully treated with cibenzoline succinate: A case report

Journal of Cardiology Cases ◽

10.1016/j.jccase.2015.01.005 ◽

2015 ◽

Vol 11 (6) ◽

pp. 155-157 ◽

Cited By ~ 1

Author(s):

Katsuhiro Tomofuji ◽

Shuntaro Ikeda ◽

Chika Murakami ◽

Yusuke Ochiumi ◽

Masayuki Nakamura ◽

...

Keyword(s):

Case Report ◽

Takotsubo Cardiomyopathy ◽

Left Ventricular

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Takotsubo cardiomyopathy after hypoglycemia in a patient with anorexia nervosa

Annals of General Psychiatry ◽

10.1186/s12991-021-00364-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Kota Kikuchi ◽

Norio Yasui-Furukori ◽

Chie Hasegawa ◽

Manami Watahiki ◽

Teruo Inoue ◽

...

Keyword(s):

Anorexia Nervosa ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Takotsubo Cardiomyopathy ◽

Psychiatric Treatment ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Apical Ballooning Syndrome ◽

Ventricular Ejection Fraction

Abstract Background Takotsubo cardiomyopathy, also known as “apical ballooning syndrome”, is generally precipitated by endogenous or exogenous stress. Eating disorders are associated with a variety of physical complications. Case presentation We present a case involving a 37-year-old Japanese female with anorexia nervosa. She was admitted because of emaciation with shortness of breath and tiredness, and her weight was 30.0 kg (BMI 10.5 kg/m2) at this admission. On the afternoon of the first day of hospitalization, a simple measurement caused hypoglycemia (20 mg/dL), and she lost consciousness. On the night of the second day of hospitalization, electrocardiogram showed negative T waves in II, III, aVf, and V1–6. Ultrasound echo showed hypokinesia at the apex of the heart and hypercontraction at the base of the heart. The left ventricular ejection fraction was 20%. Rest and oxygen administration gradually improved her cardiac function; the left ventricular ejection fraction also improved to 50% based on echocardiography. Finally, her weight increased to 43 kg (BMI 15.2 kg/m2) with psychiatric treatment, and she was discharged. Conclusions The present case shows the clinical features of Takotsubo cardiomyopathy induced by a hypoglycemic event in addition to underlying anorexia nervosa.

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Dynamic left ventricular outflow tract gradient resulting from Takotsubo cardiomyopathy ameliorated by intra-aortic balloon pump counterpulsation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab082 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Jim O’Brien ◽

Stephen Mahony ◽

Roger J Byrne ◽

Robert A Byrne

Keyword(s):

Case Report ◽

Takotsubo Cardiomyopathy ◽

Left Ventricular Outflow Tract ◽

Apical Ballooning ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Mechanical Support ◽

Intra Aortic Balloon Pump ◽

Left Ventricular Outflow

Abstract Background Takotsubo cardiomyopathy is a variant of acute coronary syndrome with characteristic acute left ventricular apical ballooning. Uncommonly, there can be associated left ventricular outflow tract (LVOT) obstruction causing cardiogenic shock refractory to inotropic support. The use of afterload-reducing mechanical support such as intra-aortic balloon pump (IABP) counterpulsation is not routinely employed in instances of this kind. Case summary In our case report, we describe a 66-year-old female with acute Takotsubo cardiomyopathy and associated LVOT obstruction which failed to respond to high-dose dobutamine and whose clinical trajectory was worsened by fast atrial fibrillation with rapid ventricular response. Within 24 h of admission, the patient had an IABP placed which rapidly improved her haemodynamics. Two days later, IABP was removed and within 6 days of admission, apical ballooning and LVOT obstruction had fully recovered. Conclusion We recommend early use of mechanical support with IABP counterpulsation to expedite recovery in patients with acute Takotsubo cardiomyopathy with associated LVOT obstruction.

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Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: A case report

Vojnosanitetski pregled ◽

10.2298/vsp170705179m ◽

2019 ◽

Vol 76 (10) ◽

pp. 1087-1093

Author(s):

Branko Milakovic ◽

Tijana Nastasovic ◽

Milan Lepic ◽

Nenad Novakovic ◽

Sinisa Matic ◽

...

Keyword(s):

Case Report ◽

Pulmonary Edema ◽

Takotsubo Cardiomyopathy ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Relevant Literature ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Apical Ballooning ◽

Left Ventricular ◽

Neurogenic Pulmonary Edema

Introduction. Subarachnoid haemorrhage (SAH) can be followed by cardiac abnormalities. We describe a patient with Takotsubo cardiomyopathy and neurogenic pulmonary edema (NPE) after aneurysmal SAH. Case report. A previously healthy, postmenopausal woman, suffered from aneurysmal SAH with consequent hydrocephalus. After external ventricular drainage, craniotomy and clipping of the posterior inferior cerebellar artery aneurysm, the patient developed acute heart failure and NPE. Transthoracic echocardiogram showed the left ventricular apical ballooning and hypercontractile basal segments. On chest radiography, bilateral pulmonary infiltrates were seen. Seventeen days after the SAH attack, the patient was discharged from hospital. Postponed coronary angiography revealed no signs of coronary artery disease. Conclusion. This case and review of the relevant literature suggest that Takotsubo cardiomyopathy and neurogenic pulmonary edema are not uncommon after aneurysmal SAH.

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