Stress Cardiomyopathy Precipitated by Withdrawal of Epoprostenol

Abstract

We describe a case of stress-induced cardiomyopathy following epoprostenol withdrawal. A patient with pulmonary arterial hypertension presented with a malfunctioning Hickman catheter. Inappropriate withdrawal of epoprostenol resulted in shock. Evaluation confirmed stress-induced cardiomyopathy. Restarting epoprostenol resolved the electrocardiographic and echocardiographic abnormalities. This case meets Taskforce on Takotsubo Syndrome Stress-Induced Cardiomyopathy criteria. ( Level of Difficulty: Beginner. )

Stress Remains in the Eye of the Beholder

“…In this issue of JACC: Case Reports, Gionfriddo et al. ( 3 ) have demonstrated the importance of identifying that acute stressors can also come in the form of withdrawal of a steady-state medication, which can lead to morbid consequences.…”

“…However, Gionfriddo et al. ( 3 ) also propose that acute pulmonary vasoconstriction following epoprostenol withdrawal could have led to right ventricular congestion with right atrial baroreceptor hyperactivation. Baroreceptor activation could have caused reflex sympathetic hyperactivation with the downstream effect of stress cardiomyopathy.…”