A ‘shark’-masked electrocardiogram: case report of a Tako-Tsubo syndrome

Abstract

Background Triangular ST-segment elevation or ‘shark-fin’ sign has been described as a specific indicator of acute coronary occlusion and large myocardial ischaemia, translating into poorer prognosis. However, this electrocardiographic presentation has been reported in rare cases of Tako-Tsubo syndrome and associated with more severe physical stressors and neurological involvement. Case summary We present a rare case of a 51-year-old woman presenting with incoming epileptic attacks and concomitant pyometra. Despite controlling epilepsy with phenytoin and the surgical treatment of the infection, she developed sepsis requiring vasopressors, and thereafter sustained ventricular tachycardia and diffuse ST-segment elevation with the ‘shark-fin’ sign. TTC was confirmed by the documentation of normal coronary arteries and the complete recovery of wall motion abnormalities at discharge. Discussion Heterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.

Epilepsy and Takotsubo cardiomyopathy: a scope review

“…After treatment, recovery of cardiac function was reported in most studies 13,17,18,[22][23][24][25] . In 9 case reports, patients showed a satisfactory clinical response, with hemodynamic stabilization at discharge, followed only by gradually discontinued symptomatic treatment [16][17][18][19][20][21][22][23][24][25] . Only one study reported death as a result of acute heart failure 13 .…”

“…The angiography findings were normal in all patients. Significant recovery of LVEF was reported days and/or weeks after discharge from these patients in six studies 13,17,[22][23][24][25] .…”

“…In nine articles some kind of change in transthoracic echocardiography was reported: seven of them had hypokinesia 13,15,19,20,22 , two akinesia 18,24 , one with posterior wall akinesia and septal wall dyskinesia 25 and two had hyperkinetic basis associated with hypokinesia and/or akinesia 17,21 .…”

“…Takotsubo cardiomyopathy related to neurological disorders such as epilepsy was associated with higher rates of adverse events. Examples include ventricular fibrillation, cardiac arrest, cardiogenic shock, septic shock 15,17,26 , increased ICU admissions 13,14,24,25 , higher in-hospital mortality 15,26 and increased all-cause readmissions 26 .…”

Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in Takotsubo Cardiomyopathy During 15 Years of Follow-Up

“…Verdoia et al reported a case of a 51 years old female that developed TTC post-sepsis in the ICU with the SFE sign. The patient regained complete sinus rhythm post-acute management and was subsequently followed up for a period of six months [18].…”