1259 From Pancreatitis to Takotsubo: A Rare Complication of Acute Pancreatitis

Abstract

INTRODUCTION: Takotsubo cardiomyopathy or stress cardiomyopathy (TCM) is a transient reversible form of cardiomyopathy. It is characterized by reduced ejection fraction and signs of myocardial ischemia and often precipitated by acute emotional or physical stressors. We present a rare case of TCM in a postmenopausal woman triggered by acute alcoholic pancreatitis. CASE DESCRIPTION/METHODS: A 57-year-old female with a history of alcohol abuse and diabetes mellitus presented to the emergency department with a two-day history of severe diffuse abdominal pain with radiation to the back. Associated symptoms included nausea and vomiting. Vital signs were within normal limits. Physical examination was significant for a mildly tender abdomen. Laboratory findings revealed leukocytosis of 14.6 and lipase of 882. All other chemistry and complete blood count labs were within normal limits. CT abdomen without contrast revealed peripancreatic fat stranding suggestive of acute pancreatitis. The patient was admitted for IV fluid resuscitation and pain management. On day 2 of admission, the patient became dyspneic and desaturated to 82% on room air. Stat chest x-ray showed flash pulmonary edema. Bedside ultrasound revealed a dilated IVC. Troponin (0.97) and BNP (1627) levels were elevated, concerning for acute heart failure exacerbation. EKG revealed no acute ischemic changes. The patient was aggressively diuresised with significant improvement in respiratory status. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 40% with basal segment hyperkinesis but apical akinesis consistent with stress-induced cardiomyopathy. Follow up coronary angiography revealed normal coronary vessels. The patient was started on guideline-based heart failure therapy and was discharged to home in stable condition. A repeat TTE obtained 4 months later revealed unchanged LVEF and persistent apical akinesis in the setting of persistent alcohol use. Guideline directed therapy was continued and the patient was counseled on alcohol cessation. DISCUSSION: Acute pancreatitis induced TCM is rare. Our case further confirms the heterogenicity of TCM, including non-classical stressors such as alcohol abuse which may delay myocardial recovery.