Tako-tsubo cardiomyopathy observed in a patient with sepsis and transient hyperthyroidism

Abstract

ischemic stroke with residual left hemiparesis, was admitted to our hospital because of dyspnoea with clinical evidence of acute pulmonary edema. She was found to have a sinus tachycardia with ST-elevation in leads D1, aVL and V1-V4 in the electrocardiogram, and akinesis of the left ventricular apex with overall left ventricular systolic function being severely impaired and an ejection fraction of 28% on echocardiography. Orotracheal intubation was performed and mechanical ventilation was immediately started. Emergency cardiac catheterization was performed 2 h after the symptom onset. Coronary angiography showed no significant coronary artery disease. Blood analysis revealed an increase in the creatine kinase MB fraction, a significant positive detection in troponin T, a white blood cell count of 35000 per microliter, C-reactive protein of 59,9 mg/dl, and transient elevation in the concentration of free triiodothyronine, free thyroxine, thyroid globulin antibody, and thyroid peroxidase antibody. The symptoms improved during the next days, and follow-up echocardiography 18 days later showed complete resolution of the left ventricular dysfunction. These data suggest that tako-tsubo cardiomyopathy may be induced in patients with sepsis and transient hyperthyroidism.

Takotsubo Cardiomyopathy Associated with Thyrotoxicosis: A Case Report and Review of the Literature

“…There have been several case reports of Takotsubo cardiomyopathy associated with hyperthyroidism. We identified a total of 12 cases in the literature (Table 2), most of which were associated with Graves' disease (37)(38)(39)(40)(41)(42). Other causes included exogenous levothyroxine intake (43-45), Hashimoto's thyroiditis (46), and toxic multinodular goiter (47).…”

CNS disease triggering Takotsubo stress cardiomyopathy

“…Searching the appropriate literature according to the criteria mentioned above revealed that TTS has been reported in association with ischemic stroke in more than 20 cases so far [100][101][102][103][104][105][106][107][108][109][110][111][112][113]. No systematic studies on the prevalence of TTS in ischemic stroke have been carried out.…”

Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient

“…It has also been postulated that hyperthyroidism predisposes to Takotsubo cardiomyopathy by acting synergistically with adrenergic hormones in states of catecholamine excess (8). Indeed, when we investigated previous case reports regarding the association of Takotsubo cardiomyopathy and thyrotoxicosis, several cases of Takotsubo cardiomyopathy were found to be complicated with thyrotoxicosis ( Table 2) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). All cases were shown to present typical signs of Takotsubo cardiomyopathy (23).…”