Takotsubo syndrome induced by brachytherapy in a patient with endocervical adenocarcinoma
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Takotsubo syndrome induced by brachytherapy in a patient with endocervical adenocarcinoma Aline Cristini Vieira1*, Mauricio Fernando Silva Almeida Ribeiro1, Julianne Lima1, Jacob Sessim Filho2, Heloisa de Andrade Carvalho3,4 and Max Senna Mano1
Abstract Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/ middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusions: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS. Keywords: Takotsubo, Brachytherapy, Endocervical adenocarcinoma, Heart failure, Stress cardiomyopathy, Broken heart syndrome
Introduction Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is an acute and transient left ventricular (LV) myocardial dysfunction, which can occur in the setting of a severe psychological or physical stress event, most * Correspondence: [email protected] 1 Oncology Center, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91. 2nd floor. Building A, 01308-050 São Paulo, Brazil Full list of author information is available at the end of the article
often occurring 1 to 5 days before [1]. TTS’s clinical presentation might be indistinguishable from an acute coronary syndrome (ACS) with respect to symptoms, electrocardiographic (ECG) changes and biomarkers. Since its first report in 1990 by Sato et al. [2]. TTS remains with no reliable non-invasive diagnostic approach, leaving coronary angiography with left ventriculography as the gold standard diagnostic tool to reject or to ratify this diagnosis to this days [3, 4]. Typica
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