Management Challenge: An Atypical Variant of Takotsubo Presenting With Multiple Complications

Abstract

An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.

A Case of Posterior Reversible Encephalopathy Due to Takotsubo Cardiomyopathy Triggered by Aerophobia

“…Currently, no standardized guidelines exist for the diagnostic and management approach to TC. Conservative management is generally effective [ 11 ]. Initially, it is important to ensure the hemodynamic stability of patients.…”

“…In refractory cases, vasopressors and left ventricular assist devices may be necessary [ 4 ]. The treatment of TC-related arrhythmias with a cardiac pacemaker or implantable cardioverter-defibrillator (ICD) remains controversial due to the reversible nature of the condition [ 11 ].…”