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• W3205555191 abstract "TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. It is often triggered by intense physical or emotional distress, and given its low incidence may be underdiagnosed. We present an unusual case TCM with normal findings on ventriculogram. CASE PRESENTATION: A 76 year old woman with Non Hodgkin Lymphoma, presented with a 5 day history of exertional dyspnea and chest pressure. Recent stressors included the death of a sister, and social isolation from a daughter recently diagnosed with breast cancer. On presentation, vital signs were BP 179/96, HR 72bpm, RR 17, SpO2 96% on room air. Electrocardiogram revealed new Q waves in the anteroseptal leads with troponin initially <0.03 ng/ml which peaked at 0.88 ng/ml. Aspirin, atorvastatin and heparin infusion were started. Cardiac catheterization on day 2 of admission revealed nonobstructive coronaries, with estimated left ventricular ejection fraction (LVEF) of 60%, with normal wall motion. Amlodipine was started for possible coronary vasospasm, however symptomatic hypotension precluded further use. Transthoracic echocardiogram on day 3 revealed an LVEF of 35%, apical ballooning and with hypercontractile base suggestive of takotsubo cardiomyopathy. She was discharged on day 3 with optimal medical therapy. DISCUSSION: There has been increasing incidence of TCM, estimated to be 15–30 cases per 100,000 per year, although the true incidence is unknown due to possible underdiagnosis and its similarity to acute coronary syndrome (ACS). Proposed mechanisms include: multivessel coronary artery spasm, impaired cardiac microvascular function and endogenous catecholamine induced myocardial stunning and microinfarction. Typically, patients are postmenopausal women who have experienced severe, unexpected emotional stress in the prior 1 to 5 days. TCM is a diagnosis of exclusion, as most cases lack significant coronary stenosis. As such, coronary angiography is the best diagnostic study. Unless contraindicated, ventriculography is usually performed and reveals the pathognomonic apical ballooning and left ventricular dysfunction. Typically only 35-40ml of contrast is needed to diagnose TCM, however these findings were not seen in this patient's ventriculogram, even though 70ml of contrast was used. Perhaps, the delay was due to the evolution of her cardiomyopathy. Regardless, a normal ventriculogram should not rule out TCM if the diagnosis is highly suspected and further imaging should be pursued. CONCLUSIONS: Stress induced cardiomyopathy should be considered in patients with significant risk factors even in the setting of normal cardiac catheterization, echocardiogram should be performed in conjunction especially if high suspicion exists. REFERENCE #1: Merchant, E. E., Johnson, S. W., Nguyen, P., Kang, C., & Mallon, W. K. (2008). Takotsubo cardiomyopathy: a case series and review of the literature. The western journal of emergency medicine, 9(2), 104–111. REFERENCE #2: Medina de Chazal, H., Del Buono, M. G., Keyser-Marcus, L., Ma, L., Moeller, F. G., Berrocal, D., & Abbate, A. (2018). Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 72(16), 1955–1971. https://doi.org/10.1016/j.jacc.2018.07.072 REFERENCE #3: Akashi, Y. J., Goldstein, D. S., Barbaro, G., & Ueyama, T. (2008). Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation, 118(25), 2754–2762. https://doi.org/10.1161/CIRCULATIONAHA.108.767012 DISCLOSURES: No relevant relationships by Tanganyika Barnes, source=Web Response No relevant relationships by Janeen Grant-Sittol, source=Web Response No relevant relationships by Anna-Belle Robertson, source=Web Response No relevant relationships by Jason Sayanlar, source=Web Response No relevant relationships by Rani Sittol, source=Web Response" @default.
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• W3205555191 date "2021-10-01" @default.
• W3205555191 modified "2023-09-25" @default.
• W3205555191 title "NOT QUITE WHAT WE PICTURED: AN UNUSUAL PRESENTATION OF TAKOTSUBO CARDIOMYOPATHY WITH NORMAL VENTRICULOGRAPHY" @default.
• W3205555191 doi "https://doi.org/10.1016/j.chest.2021.07.178" @default.
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