Midventricular Ballooning Takotsubo Cardiomyopathy Complicated by Transient Complete Atrioventricular Block

Abstract

A 63-year-old woman had mistakenly drunk detergent stored in a plastic bottle and was transported to our hospital via ambulance due to unconsciousness. In the emergency room, the monitoring electrocardiogram showed complete atrioventricular block and temporary pacing was thus started. Left ventriculography indicated midventricular Takotsubo cardiomyopathy, although coronary angiograms showed a normal appearance. The atrioventricular block was transient, and the reduced left ventricular wall motion gradually recovered. An electrophysiological study performed before discharge showed no abnormalities in the atrioventricular conduction system. In conclusion, we experienced a case of mid-ventricular Takotsubo cardiomyopathy complicated by transient complete atrioventricular block.

Supra‐Hisian Conduction Block as an Unusual Presenting Feature of Takotsubo Cardiomyopathy

“…A few cases in which EPS has been performed were suggestive of an intra‐Hisian level of the block . Interestingly, some cases with a narrow QRS escape rhythm suggesting a supra‐Hisian or intra‐Hisian level of the block are also reported . The present report may be the first one to document a supra‐Hisian level of AV block in TC with an EPS.…”

“…7,8 Interestingly, some cases with a narrow QRS escape rhythm suggesting a supra-Hisian or intra-Hisian level of the block are also reported. [9][10][11] The present report may be the first one to document a supra-Hisian level of AV block in TC with an EPS.…”

Stress-Induced Cardiomyopathy

“…Overall, the primary predictor of mortality in stress-induced cardiomyopathy is related to the underlying condition (71). Complications such as LV thrombus, cerebral infarct, and life-threatening arrhythmias have been described infrequently, with prolongation of the QTc noted as a risk factor for the development of life-threatening arrhythmias (59,60,(72)(73)(74). Elevated WBC count and brain natriuretic peptide are associated with worse clinical outcome in patients without neurologic disease with stress-induced cardiomyopathy (75).…”

Takotsubo Cardiomyopathy With Significant Coronary Stenosis and Atrioventricular Conduction Block: A Rare Case Report With 3 Year Follow-Up

“…TCMP is usually related to coronary vasospasm and microvascular disease secondary to high levels of catecholamine release; it is most commonly observed in middle-aged women and is completely reversible with supportive treatments (4). Complete heart block (CHB) with TCMP has been rarely reported in previous studies (5,6). We report a rare case of TCMP with significant coronary stenosis (70% stenosis in the left anterior descending artery, Figure 1) with transient CHB in a 45-year-old woman with a history of neurosis and controlled hypertension, as well as findings through a 3-year follow-up.…”

“…Some studies have reported that TCMP is not a distinct clinical entity, but rather a manifestation of aborted anterior myocardial infarction in patients with a long wraparound left anterior descending artery transient occlusion in the left anterior descending artery and subsequent spontaneous thrombus lysis and apical stunning and wall motion abnormalities that show improvement during follow-up after treatment (8). A review of the literature showed that although ischemia is transient in TCMP patients, an atrioventricular conduction defect with late recovery is observed (5,6). A rare case of persistent complete heart block that needed a permanent pacemaker was also reported (mostly due to a concealed disease in the atrioventricular conduction system before the onset of this cardiomyopathy) (5, 6); however, in this case, a transient high-degree atrioventricular block and a change in AV conduction (from the third to the second and the second to the first AV block) during the 3-year follow-up confirmed the functional atrioventricular block due to vagal storm in the present case.…”