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Hypotension and Takotsubo syndrome: case report A 72-year-old woman developed hypotension and Takotsubo syndrome (TTS) following treatment with nimodipine for subarachnoid haemorrhage (SAH). Her TTS was also contributed by treatment with norepinephrine for hypotension [not all dosages and time to reaction onsets stated]. The woman was hospitalised after being found lying on the floor in her flat by her neighbors. She had been smudged after vomiting and defecation and presented with a decreased level of consciousness. She reported a severe headache and denied any chest pain or dyspnoea. Upon further evaluation, she was diagnosed with SAH. Digital subtraction angiography (DSA) revealed an internal carotid artery (ICA) aneurysm. She underwent endovascular aneurysm coiling without any complication. Thereafter, she started receiving oral nimodipine. Due to recurrent vomiting, she was switched to IV infusion of nimodipine 1 mg/hour. Subsequently, she developed hypotension secondary to nimodipine therapy. The woman started receiving treatment with IV infusion of norepinephrine 0.3 mg/hour. After a few hours, she reported chest pain and shortening of breath. ECG revealed negative T waves in limb (II, III, aVF) and precordial (V3-6) leads. Laboratory investigation revealed increased levels of troponin I and BNP. In echocardiography, typical apical ballooning was visualised with decreased ejection fraction (EF) and global longitudinal strain (GLS). Chest X-ray revealed pulmonary congestion along with inflammatory changes. She was diagnosed with TTS secondary to nimodipine and norepinephrine therapy. She had severe heart failure (HF). However, her neurological status did not deteriorate. She was initiated on unspecified symptomatic treatment and antibiotic therapy. Thereafter, her condition improved. Few days later, her HF symptoms resolved. Her inflammatory changes also resolved. A week later, her LV function normalised. Fifty days later, negative T waves in ECG disappeared. Elikowski W, et al. Takotsubo syndrome after nimodipine-induced hypotension treated with norepinephrine in a female with subarachnoid hemorrhage. Polski Merkuriusz 803505521 Lekarski: Organ Polskiego Towarzystwa Lekarskiego 49: 236-240, No. 286, 22 Aug 2020. Available from: URL: https://pubmed.ncbi.nlm.nih.gov/32827417/

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Reactions 10 Oct 2020 No. 1825