Takotsubo cardiomyopathy
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itional material online This article includes three additional videos. You will find this supplemental at dx.doi. org/10.1007/s00059-012-3729-3
Takotsubo cardiomyopathy (TCM), also known as apical ballooning syndrome or broken heart syndrome, is a reversible form of acute heart failure that is often triggered by stress or an acute illness and
S. Chadha1 · A. Lodha2 · V. Shetty2 · A. Sadiq2 · G. Hollander2 · J. Shani2 1 Internal Medicine, Maimonides Medical Center, Brooklyn, NY 2 Cardiology, Maimonides Medical Center, Brooklyn
Takotsubo cardiomyopathy Presentation with sudden cardiac arrest
occurs predominantly in postmenopausal women [1]. The clinical presentation of TCM is similar to an acute myocardial infarction, since patients have chest pain, STsegment elevations, and elevated cardiac enzymes; however, cardiac catheterization reveals a normal coronary circulation. TCM is usually associated with an excellent prognosis and complete recovery [2]. We report a case of TCM where
Fig. 1 8 Electrocardiogram showing ventricular tachycardia
Fig. 2 8 Electrocardiogram in the ER showing ST-segment elevations in leads V1–V4
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the patient presented with an out-of-hospital sudden cardiac arrest.
Case report A 68-year-old Caucasian female patient with a past medical history of hypertension and diabetes mellitus suddenly collapsed while attending a church sermon. Cardiopulmonary resuscitation was initiated by the bystanders and when the
Fig. 3 8 Right coronary artery
Fig. 4 8 Left coronary circulation
Fig. 5 8 Left ventriculogram showing apical ballooning in systole
Fig. 6 8 Electrocardiogram showing QTc prolongation and T wave inversions
emergency services arrived, the patient was noted to have ventricular tachycardia (VT) (. Fig. 1). After two attempts at defibrillation, the patient had a return of spontaneous circulation and she was brought to our emergency room (ER). The patient denied any complaints of chest pain, shortness of breath, or palpitations. She had a significant family history of coronary artery disease and was a current smoker with a 40 pack-year smoking history. The patient also reported being extremely stressed recently because of financial issues. On examination, the patient’s vital signs were stable. The respiratory and cardiovascular examination was unremarkable. Laboratory test results showed a minor elevation of cardiac enzymes (troponin I, 0.36 ng/ml; CK-MB, 5.9 ng/ml) with a normal complete blood count, serum chemistry, and BNP level.
The electrocardiogram done in the ER showed ST-segment elevations in leads V1–V4 (. Fig. 2). The patient underwent an urgent cardiac catheterization that showed no obstructive coronary artery disease (. Fig. 3, 4, Video 1, Video 2), but the left ventriculogram revealed a hypercontractile basal wall and apical ballooning in systole, consistent with TCM (. Fig. 5, Video 3). An echocardiogram was performed, which confirmed the same findings. The patient was subsequently admitted to the cardiac intensive care unit for observation. The remain
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