Takotsubo cardiomyopathy complicated by cardiac tamponade due to non-hemorrhagic pericardial effusion: a case report

Abstract

Background: Cardiac tamponade is a rare but serious complication of Takotsubo cardiomyopathy (TC). Two cases of cardiac tamponade subsequent to TC have been reported. The pericardial effusion in these cases was hemorrhagic and caused by ventricular rupture. Cardiac tamponade induced by an inflammatory effusion complicated with TC has not been reported. This is the first case report of TC, which developed cardiac tamponade during the recovery phase with a large volume non-hemorrhagic inflammatory effusion. Case presentation: We describe a case of an 81-year-old woman admitted to our hospital because of severe chest pain. Her symptoms began soon after her son's hospitalization. We diagnosed her with TC based on results of an electrocardiogram, echocardiogram, and emergent coronary angiography. Her symptoms and left ventricular dysfunction improved gradually. She developed newly confirmed chest pain and dyspnea on day 9 after admission. A large pericardial effusion developed, resulting in cardiac tamponade. Her symptoms and hemodynamic status improved immediately after the pericardiocentesis. The effusion was non-hemorrhagic and exudative. No specific signs of infection, collagen disease, or malignant tumors were observed, except for TC. Conclusions: We experienced a case of circulatory collapse induced by TC-related inflammatory pericardial effusion at recovery phase. This case emphasizes the importance of careful follow-up even after improved left ventricular dysfunction in a patient with TC.

Incidence and clinical/laboratory correlates of early hypotension in takotsubo syndrome

“…The third, and theoretically perhaps the most attractive possibility, is that the extent of glycocalyx shedding might represent the common pathogenetic factor, causing hypotension via fluid ‘leakage’ and myocardial inflammation via permeabilization to monocyte and neutrophil ingress and subsequent intracardiac inflammation 22,23 . Furthermore, pleural and pericardial effusions are commonly found in TTS 24,25 and may appear independent of the impairment in cardiac output. This idea could in theory be progressed by studying the effects of inhibitors of glycocalyx shedding, such as the non‐specific matrix metalloproteinase inhibitor doxycycline 26 …”

Successful Conservative Treatment of Cardiac Rupture Associated with Takotsubo Syndrome

“…Of note, a small amount of non-hemorrhagic inflammatory effusion complicated with TTS has been reported previously ( 11 , 12 ). However, in our case, a moderate amount of pericardial effusion with high CT attenuation values suggestive of hemorrhagic pericardial effusion ( 13 , 14 ), accompanied by the progression of anemia, was observed.…”

Atypical Presentation of Takotsubo Cardiomyopathy in an Elderly Woman

“…There are few case studies that document an exudative pericardial effusion leading to tamponade physiology. 6 While the exact etiology of Takotsubo cardiomyopathy-associated pericarditis is unknown, one hypothesis is that the myocardial inflammation secondary to Takotsubo cardiomyopathy can spread to the pericardium and induce pericarditis, as seen in our patient. The first documented case of acute pericarditis following Takotsubo cardiomyopathy was seen in 2007, and the patient’s pericarditis was almost immediately ameliorated with a course of nonsteroidal anti-inflammatory medications.…”