Elsevier

Cardiovascular Pathology

Volume 30, September–October 2017, Pages 78-81
Cardiovascular Pathology

Clinical Case Report
Cardiac arrest due to ventricular fibrillation in a 23-year-old woman with broken heart syndrome

https://doi.org/10.1016/j.carpath.2017.06.007Get rights and content

Highlights

  • The age of onset was unusual at 23 years, and it may be related to cannabis use, a newly identified risk factor.

  • The autopsy showed subendocardial hemorrhages, providing a further insight in this poorly understood disease.

  • Ventricular fibrillation was the presenting scenario, and this is quite unusual.

  • If patient had survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease.

Abstract

Broken heart syndrome, also known as takotsubo cardiomyopathy, is a syndrome characterized by a transient regional systolic dysfunction of the left ventricle associated to a psychological stress. We herein describe a case of a 23-year-old female habitual marijuana user who was resuscitated after cardiac arrest and then diagnosed with midventricular stress cardiomyopathy complicated by subendocardial hemorrhage. We discuss this unique pathological finding, the incidence of arrhythmias in this syndrome, and the possible relation with chronic cannabis and tobacco use. Unfortunately, the patient did not survive, but had she survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease.

Introduction

Broken heart syndrome, also known as takotsubo cardiomyopathy, is a syndrome characterized by a transient regional systolic dysfunction of the left ventricle associated to a psychological stress and therefore constitutes a form of stress cardiomyopathy [1]. Patients with broken heart syndrome are most frequently women, presenting with chest pain and/or shortness of breath within hours or days of an emotional stress, frequently associated with electrocardiographic changes; elevation of markers of myocardial necrosis; large areas of akinetic myocardium involving circumferentially the apex, the base, or the midventricular segments in a noncoronary distribution, generally in the absence of obstructive coronary artery disease [2]. As such, these patients are classically diagnosed with the broken heart syndrome while being evaluated for possible acute myocardial infarction. Less often, however, the diagnosis of broken heart syndrome is less obvious. We herein describe a case of a 23-year-old female who was resuscitated after cardiac arrest and then diagnosed with midventricular stress cardiomyopathy.

Section snippets

Case report

A 23-year-old African–American woman was brought to the coronary intensive care unit after being resuscitated from cardiac arrest. The emergency medical personnel responding to the call found the patient in cardiac arrest with ventricular fibrillation as initial rhythm. The resuscitation efforts were very prolonged, lasting over 1 h. On admission to the coronary intensive care unit, she was comatose, hypotensive in shock, and in multiorgan failure, with evidence of hepatolysis, rhabdomyolysis,

Discussion

The diagnosis of broken heart syndrome/stress cardiomyopathy can be elusive. Before the publication of a landmark article in 2005 [2], reports of myocardial stunning due to emotional stress were anecdotal and extremely rare. More common were reports of left ventricular dysfunction in patients with subarachnoid hemorrhage or electroconvulsive therapy, providing the link between the brain and the heart [3]. The description of the syndrome has led to a surge in the incidence of stress

References (15)

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Cited by (21)

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    Other possible presentations include syncope, arrhythmias, and mitral regurgitation [5]. QT prolongation occurs frequently in these patients, with about 3.4–12.2 % of cases of TS presented with sustained ventricular tachycardia or ventricular fibrillation, and about 4.7 % with atrial fibrillation [11–13]. Approximately 10 % develop signs of cardiogenic shock, such as hypotension, cold extremities, and altered mental status [6].

  • Takotsubo Syndrome in Intensive Cardiac Care Unit: Challenges in Diagnosis and Management

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    Cardiogenic shock occurs in ≈10% of all patients.5,12,13 Symptoms caused by life-threatening arrhythmic complications such as ventricular tachycardia or cardiac arrest may also occur and reported in approximately 3% of cases.14,15 Of note, TTS patients who are already hospitalized during monitoring or treatment of another critical illness may report atypical clinical manifestations dominated by signs and symptoms of the underlying acute condition with less frequent incidence of angina-like chest pain, thus making these “secondary” Takotsubo syndromes belatedly identified or misdiagnosed in the acute phase.1 (

  • Prevalence, trends and in-hospital outcomes of takotsubo syndrome among United States cannabis users

    2020, International Journal of Cardiology
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    Recent reports suggest a link between cannabis use and sympathomimetic cardiac effects such as tachycardia and hypertension [3]. More recently, an association between cannabinoid use and stress-induced cardiomyopathy or Takotsubo Syndrome (TTS) and its related complications has been recognized [4–7]. However, large-scale data remains non-existent in regards to whether cannabis use can affect trends in the prevalence and outcomes of TTS.

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All authors have read and approved the revised version of the manuscript. The manuscript is not under review elsewhere, and none of the paper's content has been previously published. There are no conflicts of interests inherent to the current manuscript to be disclosed in the Acknowledgments section.

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