Can Gallstones Break the Heart? Pancreatitis‐Induced Takotsubo Cardiomyopathy Mimicking Acute Myocardial Infarction

Leubner, Jason K.; Ortiz, Zachary; Wolfrey, Jeffrey D.; Drake, Lauren

doi:10.1111/jgs.12999

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…To our knowledge, only 9 cases have been previously reported (Figure 3). [10][11][12][13][14][15][16] Most patients were female (7/9) and >55 years of age (7/9). All patients presented within a week of pancreatitis onset, often with shortness of breath and chest pain; however, one patient presented with sudden cardiac death.…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Abe

Simien

Hayes

2019

Journal of Investigative Medicine High Impact Case Reports

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Takotsubo cardiomyopathy or stress cardiomyopathy is a transient reversible cardiomyopathy characterized by regional wall motion abnormalities that usually extend beyond a single epicardial vascular distribution. It is often precipitated by acute physical or emotional stressors. In this article, we present the case of a postmenopausal woman who was admitted for management of acute pancreatitis. On the second day of admission, she developed shortness of breath and electrocardiographic abnormalities. A transthoracic echocardiogram revealed left ventricular systolic dysfunction and apical akinesis, and coronary angiography revealed normal coronary arteries. She was diagnosed with takotsubo cardiomyopathy triggered by acute pancreatitis and started on guideline-directed heart failure medications. A follow-up echocardiogram 4 months later revealed persistent systolic dysfunction and apical akinesis.

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Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Abe

Simien

Hayes

2019

Journal of Investigative Medicine High Impact Case Reports

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“…All these factors strongly suggest a female preponderance of TCM and, consistent with the same, the 5 reported cases of pancreatitis-induced TCM are women older than 40 years. 2 , 4 , 9 , 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis-Induced Takotsubo Cardiomyopathy in an African American Male

Bruenjes

Vallabhajosyula

Vacek

et al. 2016

ACG Case Reports Journal

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Takotsubo cardiomyopathy (TCM) is triggered by multiple physical and psychological stressors and frequently mimics acute coronary syndrome. Acute pancreatitis as a trigger for TCM has rarely been reported. We report a 55-year-old African American man with hypertension and alcohol abuse history, who presented with epigastric and sub-sternal pain and electrocardiogram demonstrating ischemic changes. Laboratory parameters revealed elevated troponin-I, amylase, lipase, and metabolic acidosis. He was diagnosed with acute pancreatitis and ACS. Coronary angiogram was unrevealing for coronary atherosclerosis and he was managed conservatively for acute pancreatitis and heart failure from TCM.

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“…Although ischemic ECG findings have been known to present in pancreatitis from the 1930s, these generally lacked 12-lead ECG data and standardized nomenclature [3, 4]. Since Bauerlein and Stobbe in 1954 [5], 36 instances of such mimicry have been noted, as shown in Table 1,Table 2, and Table 3 [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38] (clinical course, diagnostic testing, and patient outcome was not specified in one report and was omitted in the prevalence values for the respective categories). An inferior wall infarction pattern appears to be the most frequent (44.4%, or 16/36 cases).…”

Section: Reviewmentioning

confidence: 99%

“…By definition, a stress cardiomyopathy is a completely reversible LV dysfunction not instigated by coronary artery disease. Cheezum, Rajani, and others report pancreatitis-induced classic Takotsubo findings with apical akinesis with hyperbasal contraction and normal coronary arteries [11, 13, 19, 21]. Triggers can range from emotional distress and systemic illness with an estimated incidence of approximately 27 and 38%, respectively [47].…”

Section: Pathogenesis Of Electrocardiogram Changesmentioning

confidence: 99%

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

Lange

Broor

et al. 2019

Case Rep Gastroenterol

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A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.

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Can Gallstones Break the Heart? Pancreatitis‐Induced Takotsubo Cardiomyopathy Mimicking Acute Myocardial Infarction

Cited by 9 publications

References 7 publications

Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Acute Pancreatitis-Induced Takotsubo Cardiomyopathy in an African American Male

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

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