Takotsubo cardiomyopathy (TCM) is an entity of reversible cardiomyopathy known for its association with physical or emotional stress and may mimic myocardial infarction. We report an exceedingly rare case of albuterol-induced TCM with moderate asthma exacerbation. An interesting association that may help in understanding the etiology of TCM in the asthmatic population. Although the prognosis of TCM is excellent, it is crucial to recognize beta agonists as a potential stressor.

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Background: Heart Failure with preserved ejection fraction(HFpEF) is growing and common problem in elderly women with high morbidity and mortality. The role of diet in its prevention is under-researched. Objective: To evaluate calibrated and uncalibrated dietary protein, energy adjusted animal and vegetable protein and their association with incident HFpEF. Methods: Study participants in Women’s Health Initiatve (n=14,184) with valid FFQ data, free of baseline HF or missing covariates had urinary nitrogen calibrated total protein, energy calibrated using doubly labelled water animal and vegetable protein determined. Cox models adjusted for age, education, race/ethnicity, CHD, diabetes,waist to hip ration,hypertension, physical activity, systolic blood pressure, anemia, atrial fibrillation evaluated prospective association with HFpEF. HFpEF was defined as ejection fraction >45%. Results: Over 13.2 years of follow-up, there were 513 cases of HF, 268 cases of HFpEF, 162 of HFrEF and 83 of undetermined ejection fraction. Increasing levels of calibrated total protein showed a linear dose response relationship with an increased risk of HFpEF whereas uncalibrated total protein did not. Higher intake of animal protein demonstrated an increased risk , while vegetable protein showed a trend towards and inverse relationship. (see table) Conclusion: HIgher levels of calibrated total protein are associated with increased risk of HFpEF with animal protein appearing to be the most deleterious. Plant based diets with high levels of vegetable protein may be protective. Further studies should evaluate this.