An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

Parekh, Akarsh; Sengupta, Vivek; Zainea, Mark

doi:10.1093/ehjcr/ytab142

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Due to the patient’s age and the presence of the third-degree AV block on the diagnosis of TCM, it is difficult to discern whether the TCM was the cause or result of the third-degree AV block itself. In our review of the literature, we were able to identify five reports similar to our case ( Table 3 ) [ 8 , 19 , 24 , 26 , 27 ]. Cases occurred in middle-aged or elderly females.…”

Section: Discussionmentioning

confidence: 86%

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The Ominous Triad of Severe Takotsubo Cardiomyopathy

Awadelkarim¹,

Yassin²,

Ali³

et al. 2022

J Med Cases

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QT prolongation is present in 26-52% of cases of Takotsubo cardiomyopathy (TCM). It has been postulated to result from reduced cardiac repolarization reserve and reflects the transient myocardial insult observed in TCM. Bradycardia-induced QT interval prolongation is amplified by the occurrence of TCM, a combination that potentially carries a significant risk for torsade de pointes (TdP). We present a unique case of an 80-year-old female with TCM-related cardiac arrest. The patient had acquired long QT syndrome in which TCM myocardial insult led to the precipitation of a third-degree atrioventricular (AV) block and subsequent bradycardia-induced TdP. Due to the lack of robust literature, there is no clear guideline in the management of third-degree AV block in the setting of TCM. In our case, because of recurrent ventricular tachycardia (VT) and ventricular fibrillation (VF) arrest, we opted for temporary pacing at a high ventricular rate, followed by a biventricular implantable cardioverter-defibrillator (BiV/ICD). Follow-up 3 months later revealed improvement of left ventricular (LV) dysfunction and resolution of QT prolongation. However, the noticed AV conduction defects persisted. In the available literature, we identified five reported cases that bear similarity with our patient's presentation. The identified cases were middle-aged to elderly females with no significant cardiac history, who exhibited a similar triad of TCM associated with high-grade AV block, acquired long QT syndrome, and a rapid progression of bradycardia-induced TdP, resulting in a near cardiac arrest within the first 24 -48 h of admission. It is crucial to monitor corrected QT (QTc), correct electrolyte abnormalities, and minimize QT-prolonging medications in patients with TCM. The recognition of AV conduction defects in patients with TCM is critical, especially if it is associated with significant QT prolongation. Such situations are underrecognized, and are potentially fatal, necessitating close monitoring and timely intervention.

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Section: Discussionmentioning

confidence: 86%

“…This likely resulted in an R over T phenomenon, which precipitated the VF with sudden cardiac arrest. The occurrence of TCM amplifies QT interval prolongation in multiple similar literature [ 14 , 18 , 19 ]. Additionally, hypomagnesemia and the administration of ondansetron likely contributed to the QT prolongation.…”

Section: Discussionmentioning

confidence: 99%

The Ominous Triad of Severe Takotsubo Cardiomyopathy

Awadelkarim¹,

Yassin²,

Ali³

et al. 2022

J Med Cases

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“…177 Nevertheless, several cases of TTS developing malignant VAs have received an ICD, commonly via a shared decision-making process. 43,172,173,178,179…”

Section: Treatment and Prophylaxismentioning

confidence: 99%

Takotsubo Syndrome and Sudden Cardiac Death

Manolis

Manolis²,

Melita

et al. 2022

Angiology

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Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4–5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated.

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Takotsubo Syndrome Presenting with Syncope and Third-Degree Atrioventricular Block Requiring Permanent Pacemaker Implantation

et al. 2022

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Takotsubo syndrome (TS) is an acute but transient heart failure syndrome and it is very uncommon for TS to present as syncope with complete atrioventricular (AV)block.In this report,we aimed to present a case of TS complicated by third-degree AV block presented to the emergency department with syncope and requiring permanent pacemaker implantation.A 53-year-old female admitted to our emergency department with complaints of syncopal episodes and chest pain.Due to ongoing chest pain,electrocardiography (ECG) findings and segmentary wall motion abnormality on the transthoracic echocardiography (TTE),she was immediately transferred to cardiac catheterization laboratory.Coronary angiogram revealed normal coronary arteries and left ventriculography demonstrated apical ballooning and hypokinesis of the apex.As the diagnosis of TS was established,patient was transferred to coronary intensive care unit(CICU).Initial ECG at CICU demonstrated complete AV block with a heart rate of 35 beats/min.On third day of hospitalization,repeat TTE showed improved left ventricular functions with an ejection fraction of 50%.During the follow-up period in CICU,complete AV block persisted and the rhythm did not return to normal sinus rhythm after 6 days of monitorization.An electrophysiologic study demonstrated supra-hisian atrioventricular block and atrioventricular dissociation.On seventh day of hospitalization,TTE demonstrated recovered ventricular functions with an ejection fraction of 65% and a dual pacemaker was then implanted.Her third month follow-up was uneventful and TTE showed normal left ventricular functions but pacemaker interrogation revealed 99% of ventricular pacing.This case report demonstrated that,the decision to implant a permanent pacemaker on such patients should be considered on a case-by-case basis,and electrophysiologic study could be valuable on this decision.

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An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

Cited by 3 publications

References 11 publications

The Ominous Triad of Severe Takotsubo Cardiomyopathy

The Ominous Triad of Severe Takotsubo Cardiomyopathy

Takotsubo Syndrome and Sudden Cardiac Death

Takotsubo Syndrome Presenting with Syncope and Third-Degree Atrioventricular Block Requiring Permanent Pacemaker Implantation

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