Citation

Azouzi A, Omri M, Kraiem H, Mbarek H, Slim M, Boussarsar M. Cor Vasa 2019; 61(3): E319-E322.

Copyright

(Copyright © 2019, Avicenum [etc.] Basel, distributed by Karger-Libri AG.)

DOI

10.1016/j.crvasa.2018.06.004

PMID

unavailable

Abstract

BACKGROUND: Takotsubo cardiomyopathy is a transient left ventricular dysfunction with wall-motion abnormalities which mimics myocardial infarction without acute coronary disease. Physiopathology of this entity remains unclear and different hypotheses are given. We present a case of a multifactor induced takutsubo cardiomyopathy in a young 18-year-old man. Case presentation: A previously healthy 18-year-old North African male presented to the emergency department for beta-blocker poisoning (propranolol). Physical examination revealed signs of circulatory failure with cardiac conduction disturbances. The patient's hemodynamic status stabilized after fluid challenge and ephedrine infusion. On second day of hospitalization, the patient developed chest pain and dyspnea. Electrocardiogram showed an anterolateral ST segment elevation and troponin was elevated at 8.4 ng/ml. Transthoracic echocardiography revealed a reduced left ventricular ejection fraction (40%) and apical akinesia. An urgent coronarography revealed normal coronary arteries and ventriculography showed apical ballooning with preserved basal contraction. The diagnosis of Takotsubo cardiomyopathy was made. Supportive therapy allowed hemodynamic improvement. The outcome was favorable with complete resolution of symptoms and normalization of left ventricular function.

DISCUSSION and conclusions: In conclusion, Takotsubo cardiomyopathy was probably triggered in the present case by the association of three etiologies: emotional stress, epinephrine infusion and beta-blocker poisoning. Physicians should be aware of possible iatrogenic triggers of this disease, especially the harmful effects of catecholamine on heart function and/or poisoning with cardiotoxic drugs. © 2019 Elsevier Science B.V.. All rights reserved.

Language: en

Keywords

adult; human; male; Poisoning; case report; anxiety; suicide attempt; Case report; clinical article; physical examination; emergency ward; confusion; fluid therapy; intensive care; hypotension; heart rate; akinesia; bicarbonate; electrocardiogram; Glasgow coma scale; dyspnea; glucagon; thorax pain; iatrogenic disease; ST segment elevation; oxygen saturation; Article; diuretic agent; heart left ventricle ejection fraction; transthoracic echocardiography; continuous infusion; young adult; lung auscultation; troponin I; isotonic solution; Iatrogenic disease; sinus rhythm; takotsubo cardiomyopathy; heart ventriculography; noninvasive ventilation; clinical outcome; crackle; retrosternal pain; diuretic therapy; heart left bundle branch block; epinephrine; acebutolol; Apical ballooning syndrome; Catecholamine cardiotoxicity; first degree atrioventricular block; Stress-induced cardiomyopathy; Takotsubo cardiomyopathy