Recurrence of Postoperative Stress-Induced Cardiomyopathy Resulting from Status Epilepticus

Abstract

Introduction. Classically, stress-induced cardiomyopathy (SIC), also known as takotsubo cardiomyopathy, displays the pathognomonic feature of reversible left ventricular apical ballooning without coronary artery stenosis following stressful event(s). Temporary reduction in ejection fraction (EF) resolves spontaneously. Variants of SIC exhibiting mid-ventricular regional wall motion abnormalities have been identified. Recent case series present SIC as a finding in association with sudden unexplained death in epilepsy (SUDEP). This case presents a patient who develops recurrence of nonapical cardiomyopathy secondary to status epilepticus. Case Report. Involving a postoperative, postmenopausal woman having two distinct episodes of status epilepticus (SE) preceding two incidents of SIC. Preoperative transthoracic echocardiogram (TTE) confirms the patient's baseline EF of 60% prior to the second event. Postoperatively, SE occurs, and the initial electrocardiogram exhibits T-wave inversions with subsequent elevation of troponin I. Postoperative TTE shows an EF of 30% with mid-ventricular wall akinesia restoring baseline EF rapidly. Conclusion. This case identifies the need to understand SIC and its diagnostic criteria, especially when cardiac catheterization is neither indicated nor available. Sudden cardiac death should be considered as a possible complication of refractory status epilepticus. The pathophysiology in SUDEP is currently unknown; yet a correlation between SUDEP and SIC is hypothesized to exist.

Immediate versus delayed detection of Takotsubo syndrome after epileptic seizures

“…The ECG was normal in only one patient with immediate detection of TTS (Table 1) [4]. In the remaining patients, one or more ECG abnormalities were detected, as listed in Tables 1 and 2.…”

“…Most articles were reports about a single case, 5 articles comprised case series [17][18][19][20][21]. In 23 cases, TTS was reported to develop immediately after the seizure and signs of TTS were already present at hospital admission (Table 1) [4][5][6]8,9,13,14,16,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. In the remaining 25 cases, detection of TTS was reported 5-288 (mean 50) hours after the seizure (Table 2) [3,[10][11][12][17][18][19][35][36][37][38][39][40][41][42][43][44][45][46]…”

“…TTS predominantly affects elderly women and is often preceded by emotional or physical stress [1]. Epileptic seizures as triggering events of TTS are, so far, described in > 100 cases [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Seizure-induced TTS may occur immediately after the seizure and can be diagnosed at hospital admission.…”

Stress Cardiomyopathy Triggered by Status Epilepticus Secondary to Herpes Simplex Virus Encephalitis: Case Report and Literature Review

“…Cardiac catheterization could not be done in our patient due to risks linked to her resistant status epilepticus; in addition, other diagnostic information points to SCM as a likely diagnosis. However, cardiac catheterization is not mandatory in typical SCM [ 9 ]. Resolution of cardiac dysfunction ultimately occurred within five days, excluding the need for cardiac catheterization.…”

A pragmatic approach to intravenous anaesthetics and electroencephalographic endpoints for the treatment of refractory and super-refractory status epilepticus in critical care

“…This may require cardiac electrophysiology input for percutaneous pacemaker insertion. Cardiac contractility impairment such as stress-induced cardiomyopathy (Takotsubo syndrome) are often associated with acute brain injury [121], and recently it has been reported as a manifestation resulting from RSE [122]. Management of this is principally supportive but may require interventional cardiac support if severe [123].…”