Variant of takotsubo cardiomyopathy associated with sepsis and respiratory failure in an elderly female

Punnaiah Marella, Shantipriya Siripurapu, Hassan Hussein, Rajeev Garg

Department of Cardiology, Banner Estrella Medical Center, Phoenix, USA.
Department of Internal Medicine, Banner Estrella Medical Center, Phoenix, USA.
Department of Internal Medicine, West Valley Hospital, Goodyear, USA.

DOI: 10.4236/wjcd.2013.31003                

Abstract

Stress induced cardiomyopathy/Takotsubo cardiomyopathy (TSO CMO) has been widely reported. It is characterized by apical hypokinesis or akinesis. Variants of this called as inverted/reverse cardiomyopathies have been reported and are characterized by basal hypokinesis/akinesis and hypercontractility of apex. These are more common in younger population. We present an elderly female who had a variant cardiomyopathy in association with sepsis and respiratory failure and this has been rarely reported. An 84 year old female presented with cough, dyspnea and fevers. She was treated for pneumonia but her respiratory failure worsened and she suffered a non ST segment elevation myocardial infarction. Cardiac catheterization revealed normal coronaries but ejection fraction was low at 25% with basal hypokinesis and a hyperkinetic apex. She improved with diuresis and medical management of a variant of stress induced cardiomyopathy. Stress induced cardiomyopathies and its variants are reversible conditions and improve with conservative management. These entities should be kept in mind during investigation of any acute myocardial infarction.

Keywords

Takotsubo Cardiomyopathy; Inverted Cardiomyopathy; Stress Induced Cardiomyopathy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dote, K., Sato, H., Tateishi, H., Uchida, T. and Ishihara, M. (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: A review of 5 cases. Journal of Cardiology, 1, 203-214.
[2]	Yasu, T., Tone, K., Kubo, N. and Saito, M. (2006) Transient mid-ventricular ballooning cardiomyopathy: A new entity of takotsubo cardiomyopathy. International Journal of Cardiology, 110, 100-101. doi:10.1016/j.ijcard.2005.05.060
[3]	Nanda, S., Pamula, J., Bhatt, S.P., Chan, I., Turki, M.A. and Dale, T.H. (2007) Ta-kotsubo cardiomyopathy—A new variant and widening disease spectrum. International Journal of Cardiology, 120, e34-e36. doi:10.1016/j.ijcard.2007.04.067
[4]	Gianni, M., Dentali, F., Grandi, A.M., Sumner, G., Hira-lal, R. and Lonn, E. (2006) Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. European Heart Journal, 27, 1523-1529. doi:10.1093/eurheartj/ehl032
[5]	Sasaki, O., Nishioka, T., Akima, T., Tabata, H., Okamoto, Y., Akanuma, M., et al. (2006) Association of takotsubo cardiomyopathy and long QT syndrome. Circulation Jour- nal, 70, 1220-1222. doi:10.1253/circj.70.1220
[6]	Kurowski, V., Kaiser, A., von Hof, K., Killermann, D.P., Mayer, B., Hartmann, F., et al. (2007) Apical and mid-entricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): Frequency, mechanisms, and prognosis. Chest, 132, 809-816. doi:10.1378/chest.07-0608
[7]	Bonnemeier, H., Demming, T., Weidtmann, B., Ortak, J., Burgdorf, C., Reppel, M., et al. (2010) Differential heart rate dynamics in transient left ventricular apical and mid- ventricular ballooning. Heart Rhythm, 7, 1825-1832. doi:10.1016/j.hrthm.2010.08.025
[8]	Mansencal, N., Abbou, N., N’Guetta, R., Pilliere, R., El Mahmoud, R. and Dubourg, O. (20110) Apical-sparing variant of tako-tsubo cardiomyopathy: Prevalence and characteristics. Archives of Cardiovascular Diseases, 103, 75-79.
[9]	Ramaraj, R. and Movahed, M.R. (2010) Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congestive Heart Failure, 16, 284-286. doi:10.1111/j.1751-7133.2010.00188.x
[10]	Fazio, G., Barbaro, G., Sutera, L., Guttilla, D., Pizzuto, C., Azzarelli, S., et al. (2008) Clinical findings of takotsubo cardiomyopathy: Results from a multicenter international study. Journal of Cardiovascular Medicine (Hagerstown), 9, 239-244. doi:10.2459/JCM.0b013e328216276d