Care of Patients Who Have Cardiac DysrhythmiasSudden cardiac death: An increasingly recognized presentation of apical ballooning syndrome (Takotsubo cardiomyopathy)
Introduction
Apical ballooning syndrome (ABS), also known as “Broken Heart Syndrome” and Takotsubo/Stress cardiomyopathy, is a mimic of acute coronary syndrome which typically occurs following physical or emotional distress. Acute heart failure and cardiogenic shock are the two frequent complications of ABS, but ventricular arrhythmias (VA) may also occur. We present a case of a woman who was resuscitated following an out-of-hospital (OOH) cardiac arrest that developed following the death of her father and had clinical features of ABS. We also review the literature and describe the incidence and potential mechanisms of sudden cardiac death (SCD) in ABS.
Section snippets
Case presentation
Our case involves a 61-year-old woman without cardiovascular risk factors who was previously in a normal state of health. She had no chronic illnesses and was not taking any medications. On the morning of admission, she unexpectedly found her 95-year-old father dead which resulted in severe distress and sadness. She spent the following hours making funeral arrangements. Later that day while seated as a passenger in her sister's car, she suddenly slumped forward, lost consciousness and stopped
Discussion
ABS is an uncommon but well recognized condition that is often initially misdiagnosed as an acute coronary syndrome because patients typically present with chest pain and dyspnea with ECG and biomarker evidence of myocardial injury or ischemia. It is estimated to account for 1–2% of patients presenting with acute myocardial infarction and ST-elevation is the most common ECG abnormality at presentation.1 ABS is a reversible cardiomyopathy which predominantly occurs in postmenopausal women
Conclusion
SCD is an increasingly recognized presentation of ABS. The actual incidence of OOH cardiac arrest with ABS may be higher than reported as patients with OOH arrest may not survive to hospital arrival and diagnosis. ABS should be considered in the differential diagnosis of SCD among patients who present following major emotional or physical stressors. Obtaining a detailed history and probing for provoking stressors may aid in the diagnosis of ABS in OOH arrest survivors. Patients with acute ABS
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Ventricular Arrhythmias in Takotsubo Cardiomyopathy
2018, Cardiac Electrophysiology: From Cell to Bedside: Seventh EditionEditorial Commentary: Sudden cardiac death: We shall never surrender
2016, Trends in Cardiovascular MedicineMyocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy
2015, Heart RhythmCitation Excerpt :Life-threatening ventricular arrhythmias most often occur in the subacute phase (on the second and third day of hospitalization) at the same time of anterolateral T-wave inversion and QT interval prolongation.15–21 Clinical studies specifically addressing the incidence and outcome of ventricular arrhythmias in patients with TTC consistently showed that the majority of malignant arrhythmic episodes were related to QT interval prolongation (QTc interval >500 ms), with pause-dependent torsades de pointes degenerating into VF.15–21 Long-short sequences preceding torsades de pointes/VF have also been reported, which were similar to those traditionally recognized as arrhythmia triggers in acquired long QT syndrome (Figure 6).
Natural history of cardiac arrest in patients with takotsubo cardiomyopathy
2015, American Journal of CardiologyCitation Excerpt :Titles and abstracts were reviewed for all the short-listed citations, and 118 reports were chosen for full-text review. Of the 118 full-text reports reviewed for eligibility, 62 met all the inclusion and exclusion criteria3,5–65 (Table 1). All studies were observational single-patient case reports or case series of patients.
Clinical Profile of Patients with High-Risk Tako-Tsubo Cardiomyopathy
2015, American Journal of CardiologyCitation Excerpt :This observation could represent increased TTC awareness, enhanced referral of cardiac arrest patients to our institution because of implementation of a regional therapeutic hypothermia program in 2006,20 or a random clustering of events. These findings are consistent with previous reports of cardiac arrest in TTC.4,21–24 With regard to the cardiac arrest patients, it remains unresolved whether the TTC event was the cause or alternatively the consequence of the arrhythmia.
Inotropic agents in apical ballooning syndrome: A therapeutical dilemma
2013, Heart and Lung: Journal of Acute and Critical Care
Disclosures: The authors report no conflicts of interest or sources of funding.