Tako-tsubo cardiomyopathy in a male patient after administration of isoproterenol and implantation of a pacemaker


Background: Tako-tsubo cardiomyopathy occurs typicallly after an intrinsic adrenergic hyperstimulation triggered by a psychological or physically stressful event. Exceptionally, it may be caused by an exogenous hyperadrenergism. We report the case of an 85 year old man, hypertensive, with a history of ischemic stroke. He consulted for signs of heart failure with recurrent dizziness two weeks which was explained by an atrioventricular block. Initial echocardiography showed left ventricular ejection fraction to 60% with no wall motion abnormalities. The patient received iso-prenaline (0.02 mcg/kg/mn) for 20 hours before the implantation of a single chamber pacemaker. At 24 hours of admission an acute pulmonary edema occurred. The control echocardiography showed impaired left ventricular ejection fraction of 25% with apical ballooning and akinesis was also found on ventricu-lography. Coronary angiography showed no significant coronary lesions. Troponin level was elevated to 2 ng/ml. The pulmonary edema was then controlled. Subsequent clinical and echocardiographic were favo- rable after two weeks which was consistent with the diagnosis of tako-tsubo cardiomyopathy. Conclusion: This case illustrates an example of tako-tsubo syndrome induced by an exogenous catecholergic stimulation (isoprenaline) combined with an endogenous release after a pacemaker implantation which confirmed the physiopathological hypothesis of a catecholamine-mediated stunning in tako-tsubo cardiomyopathy.

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Zghal, F. , Trabelsi, R. , Mbarki, S. , Cherif, G. , Moussa, N. , Mourali, M. and Mechmeche, R. (2012) Tako-tsubo cardiomyopathy in a male patient after administration of isoproterenol and implantation of a pacemaker. World Journal of Cardiovascular Diseases, 2, 38-41. doi: 10.4236/wjcd.2012.21007.

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The authors declare no conflicts of interest.


[1] Gianni, M., Dentali, F., Grandi, A.M., et al. (2006) Apical bal-looning syndrome or takotsubo cardiomyopathy: A systematic review. European Heart Journal, 27, 1523- 1529. doi:10.1093/eurheartj/ehl032
[2] Nef, H.M., M?llmann, H., Akashi, Y.J., et al. (2010) Me- chanisms of stress (Takotsubo) cardiomyopathy. Nature Reviews Cardiology, 7, 187-193. doi:10.1038/nrcardio.2010.16
[3] Dewachter, P. and Mou-ton-Faivre, C. (2010) Possible link between apical ballooning syndrome during anaphylaxis and inappropriate administration of epinephrine. Ma- yo Clinical Proceeding, 85, 396-400. doi:10.4065/mcp.2009.0699
[4] Saito, R., Takahashi, T., Noshita, N., et al. (2010) Ta- kotsubo cardiomyopathy induced by dobutamine infusion during hypertensive therapy for symptomatic vasospasm after subarachnoid hemorrhage-case report. Neurologia Medico-Chirurgica (Tokyo), 50, 393-395. doi:10.2176/nmc.50.393
[5] Margey, R., Diamond, P., McCann, H., et al. (2009) Do- butamine stress echo-induced apical ballooning (Tako- tsubo) syndrome. European Journal of Echocardiogra- phy, 10, 395-399. doi:10.1093/ejechocard/jen292
[6] Shah, B.N., Simpson, I.A. and Rakhit, D.J. (2011) Ta- kotsubo (apical ballooning) syndrome in the recovery period following dobutamine stress echocardiography: A first report. European Journal of Echocardiography, 12, E5. doi:10.1093/ejechocard/jeq107
[7] Mori, H., Ishikawa, S., Kojima, S., et al. (1993) Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovascular Research, 27, 192-198. doi:10.1093/cvr/27.2.192
[8] Kurisu, S., Inoue, I., Kawagoe, T., et al. (2006) Persistent left ventricular dysfunction in takotsubo cardiomyopathy after pacemaker implantation. Circulation Journal, 70, 641- 614. doi:10.1253/circj.70.641
[9] Chun, S.G., Kwok, V., Pang, D., et al. (2007) Transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy) as a complication of permanent pacemaker implantation. International Journal of Cardiology, 117, e27-e30. doi:10.1016/j.ijcard.2006.11.125
[10] Kohnen, R.F. and Baur, L.H.B. (2009) A Dutch case of a takotsubo cardiomyopathy after pacemaker Implantation. Netherlands Heart Journal, 17, 487-490. doi:10.1007/BF03086309
[11] Abu Sham’a, R.A., Asher, E., Luria, D., et al. (2009) Apical ballooning syndrome: A complication of dual chamber pacemaker implantation. Indian Pacing and Electrophysiology Journal, 9, 229-232.
[12] Kimura, K., Tanabe-Hayashi, Y., Noma, S., et al. (2007) Images in cardiovascular medicine. Rapid formation of left ventricular giant thrombus with Takotsubo cardiomyopathy. Circulation, 115, e620-e621. doi:10.1161/CIRCULATIONAHA.106.673947
[13] Brunetti, N.D., Ieva, R., Correale, M., et al. (2011) Combined exogenous and endogenous catecholamine release associated with ta-ko-tsubo like syndrome in a patient with atrio-ventricular block undergoing pace-maker implantation. Acute Card Care, 13, 112-114. doi:10.3109/17482941.2011.553236
[14] Wielusiński, M., Ka?mierczak, J., Kiedrowicz, R., et al. (2011) Tako-tsubo cardiomyopathy following complete atrioven-tricular nodal heart block during transcatheter ra- diofrequency ablation of atrioventricular nodal reentrant tachycardia. Kardiologia Polska, 69, 508-509.
[15] Liu, S. and Dhamee, M.S. (2010) Perioperative transient left ventricular apical ballooning syndrome: Takotsubo car- diomyopathy: A review. Clinical Anesth, 22, 64-70. doi:10.1016/j.jclinane.2009.03.010

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