Life-threatening Takotsubo Cardiomyopathy

Abstract

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

When the brain hurts the heart: status epilepticus inducing tako‐tsubo cardiomyopathy

“…Based on the literature review, we included 19 papers (Sakuragi et al ., 2007; Shimizu et al ., 2008; Bosca et al ., 2008; Legriel et al ., 2008; Seow et al ., 2008; Lemke et al ., 2008; Fugate et al ., 2009; Benyounes et al ., 2011; Mrejen‐Shakin et al ., 2011; Rodriguez de Antonio et al ., 2011; Traullé et al ., 2011; Wakabayashi et al ., 2011; Finsterer et al ., 2013; Hocker et al ., 2013; Belcour et al ., 2015; Koo et al ., 2015; Srivastava et al ., 2016; Uemura et al ., 2016; Miller et al ., 2017) comprising a total of 42 cases. Together with our patients, 45 cases of TTC induced by SE were reviewed (see table for a summary of the studies and supplementary tables 1–3 for details of each study/patient).…”

“…Based on this assumption, it is possible that in our first two cases, the initial convulsion caused the TTC. Although in the great majority of patients, TCC has a benign course leading to a complete recovery, there are some reports of life-threatening complications such as cardiogenic shock, pulmonary oedema, arrhythmias, and left ventricle thrombus that could lead to stroke (Mrejen-Shakin et al, 2011;Wakabayashi et al, 2011). Moreover, catecholamine-related myocardial injury may be a relevant mechanism of sudden unexpected death in epilepsy (SUDEP) (Nashef et al, 2012;Al-Najafi and Rosman, 2015;Miller et al, 2017) even though this seems to be a rare event (Stöllberger et al, 2011;Finsterer and Bersano, 2015).…”

“…Clinically, TTC can be characterized by an acute onset of chest pain and dyspnoea, but is frequently completely asymptomatic and easily unrecognized. Nevertheless, in some cases, it can evolve into pulmonary oedema, arrhythmias, intraventricular thrombus with risk of cardio-embolic stroke, and cardiogenic shock requiring intensive care unit (ICU) admission and intensive care management (amine support and diuretic therapy), thus becoming a life-threatening condition (risk of lethal arrhythmia or septal perforation) (Mrejen-Shakin et al, 2011;Wakabayashi et al, 2011). Creatine kinase (CK), the isoenzyme CK-MB, troponin, myoglobin, and brain natriuretic peptide (BNP) can be transiently and mildly/moderately elevated.…”

Takotsubo Syndrome and Sudden Cardiac Death

“…A 50-year-old woman having multiple epileptic seizures and later developing acute heart failure complicated by VF and shock was diagnosed with TTS. 116 The hemodynamic abnormalities were restored with defibrillation, mechanical ventilation, and support with inotropic and pressor agents, while the apical ballooning and systolic impairment reversed, with the echocardiogram normalizing within 3 months. Another case of a seizure-associated TTS was reported in a 67-year-old woman who sustained cardiac arrest due to VF as the first clinical manifestation of TTS, noted approximately 48 h following a seizure, with normalization of LV systolic function observed at 4 weeks.…”

Multi-Omics Analysis Reveals the Role of Sigma-1 Receptor in a Takotsubo-like Cardiomyopathy Model

“…A comment on the heightened risk of developing TTS in post-menopausal women is due to the lack of estrogen, a phenomenon commonly observed in clinical practice [4][5][6][7]. Studies have demonstrated a correlation between TTS and serious complications, including death, because of the development of cardiovascular complications such as cardiogenic shock and life-threatening arrhythmias [8][9][10]. Particularly in the context of the COVID-19 pandemic, accurate diagnosis of TTS has become more challenging.…”