Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome" is a reversible form of acute heart failure characterized by temporary left ventricular dysfunction, typically precipitated by intense emotional or physical distress. Its clinical presentation mimics that of acute coronary syndrome with chest pain, shortness of breath, elevated troponins, and sometimes with electrocardiogram(EKG) changes, which makes initial diagnosis challenging. This case report presents a Takotsubo cardiomyopathy in an 81-year-old female, which developed after the loss of her beloved Basenji puppy.
Case Report: An 81-year-old female presented to the emergency department(ED) with worsening dyspnea for one day. On the day before admission, she had a long car journey to return the Basenji puppy that she bought 3 months ago. The patient reports she loved her puppy but had to return the puppy due to the amount of mass it was causing at home. After the trip, she felt extreme fatigue and dyspnea with walking from a room to a bathroom, prompting her ED visit. On admission, she revealed a pulse rate of 92, blood pressure within normal range, and had signs of respiratory distress. Chest X-ray showed characteristic COPD changes without signs of cardiomegaly or pulmonary edema. A CT angiogram ruled out pulmonary embolism. Laboratory investigations revealed an elevated BNP at 1136 and elevated high-sensitivity cardiac troponins peaking at 546, followed by subsequent readings at 351 and 313. An EKG demonstrated normal sinus rhythm with occasional premature ventricular contractions. An echocardiogram(ECHO) displayed severe LV dysfunction, estimating a LVEF of 25-30%. This was characterized by akinesis of multiple walls (anterior, anteroseptal, apical lateral, mid inferior, and inferior apical), limited apical dyskinesia, and grade 3 diastolic dysfunction. Left heart catheterization revealed LV apical ballooning extending beyond the Left Anterior Descending artery's territory, consistent with Takotsubo cardiomyopathy. Minor non-obstructive coronary artery disease with 30% stenosis at multiple locations was observed (mid LAD, ostial first diagonal, ostial RCA, and mid RCA).
After establishing the diagnosis of Takotsubo cardiomyopathy, recommendations were made to start a short course of diuretics for management of acute systolic congestive heart failure. A plan was set for a repeat ECHO before discharge to reassess LVEF, with consideration for a LifeVest if LVEF remained at or below 35%. The patient's clinical status improved with her repeat ECHO on day 3 demonstrated a slight improvement in LVEF to 36-40%. She was discharged with recommendations for close outpatient follow-up, optimization of medical therapy for heart failure with short-term beta blocker and diuretics therapy, and counseling for coping with emotional stressors.
Discussion: Takotsubo cardiomyopathy is typically precipitated by intense psychological stress and primarily occurs in postmenopausal women. The characteristic finding of apical ballooning is seen in left ventriculography or ECHO. Despite frequent hemodynamic compromise, most of the patients recover completely within the next few weeks. This case emphasizes the potential development of Takotsubo cardiomyopathy secondary to severe emotional stress, which can differ among individuals. Identifying stressors and adjusting medications based on patient history is crucial for optimal management.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Cho, Eunbee; Ganiyu, Shakirat; Dorsey Trevino, Edgar; Gonzalez Morales, Elimar; and Chaglasian, Johanne, "The Dog That Broke My Heart" (2024). Research Symposium. 64.
https://scholarworks.utrgv.edu/somrs/2024/posters/64
Basenji dog
takotsubo.jpg (74 kB)
left ventriculogram of this patient during left heart catheterization
Included in
The Dog That Broke My Heart
Introduction: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome" is a reversible form of acute heart failure characterized by temporary left ventricular dysfunction, typically precipitated by intense emotional or physical distress. Its clinical presentation mimics that of acute coronary syndrome with chest pain, shortness of breath, elevated troponins, and sometimes with electrocardiogram(EKG) changes, which makes initial diagnosis challenging. This case report presents a Takotsubo cardiomyopathy in an 81-year-old female, which developed after the loss of her beloved Basenji puppy.
Case Report: An 81-year-old female presented to the emergency department(ED) with worsening dyspnea for one day. On the day before admission, she had a long car journey to return the Basenji puppy that she bought 3 months ago. The patient reports she loved her puppy but had to return the puppy due to the amount of mass it was causing at home. After the trip, she felt extreme fatigue and dyspnea with walking from a room to a bathroom, prompting her ED visit. On admission, she revealed a pulse rate of 92, blood pressure within normal range, and had signs of respiratory distress. Chest X-ray showed characteristic COPD changes without signs of cardiomegaly or pulmonary edema. A CT angiogram ruled out pulmonary embolism. Laboratory investigations revealed an elevated BNP at 1136 and elevated high-sensitivity cardiac troponins peaking at 546, followed by subsequent readings at 351 and 313. An EKG demonstrated normal sinus rhythm with occasional premature ventricular contractions. An echocardiogram(ECHO) displayed severe LV dysfunction, estimating a LVEF of 25-30%. This was characterized by akinesis of multiple walls (anterior, anteroseptal, apical lateral, mid inferior, and inferior apical), limited apical dyskinesia, and grade 3 diastolic dysfunction. Left heart catheterization revealed LV apical ballooning extending beyond the Left Anterior Descending artery's territory, consistent with Takotsubo cardiomyopathy. Minor non-obstructive coronary artery disease with 30% stenosis at multiple locations was observed (mid LAD, ostial first diagonal, ostial RCA, and mid RCA).
After establishing the diagnosis of Takotsubo cardiomyopathy, recommendations were made to start a short course of diuretics for management of acute systolic congestive heart failure. A plan was set for a repeat ECHO before discharge to reassess LVEF, with consideration for a LifeVest if LVEF remained at or below 35%. The patient's clinical status improved with her repeat ECHO on day 3 demonstrated a slight improvement in LVEF to 36-40%. She was discharged with recommendations for close outpatient follow-up, optimization of medical therapy for heart failure with short-term beta blocker and diuretics therapy, and counseling for coping with emotional stressors.
Discussion: Takotsubo cardiomyopathy is typically precipitated by intense psychological stress and primarily occurs in postmenopausal women. The characteristic finding of apical ballooning is seen in left ventriculography or ECHO. Despite frequent hemodynamic compromise, most of the patients recover completely within the next few weeks. This case emphasizes the potential development of Takotsubo cardiomyopathy secondary to severe emotional stress, which can differ among individuals. Identifying stressors and adjusting medications based on patient history is crucial for optimal management.