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Cardiovascular Disease |

Recurrent Right Ventricular Takotsubo Cardiomyopathy in a Diabetic Patient With Recurrent Aspiration

Joanna Paula Sta. Cruz, MD; Jose Codolosa, MD
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Albert Einstein Medical Center, Philadelphia, PA


Chest. 2014;145(3_MeetingAbstracts):65A. doi:10.1378/chest.1782575
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Abstract

SESSION TITLE: Cardiovascular Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To describe a novel case of recurrent isolated right ventricular takotsubo cardiomyopathy and discuss the role of autonomic dysfunction and regional differences in myocardial sympathetic innervation in this condition.

METHODS: Review of patient records and literature

RESULTS: A 28-year-old man with insulin-dependent diabetes mellitus, presented with recurrent diabetic ketoacidosis and aspiration requiring mechanical ventilation. Such episodes were complicated by pulseless electrical activity, bradycardia, and ventricular tachycardia (VT) leading to cardiorespiratory arrests. Echocardiography showed hypokinesis of the mid and apical segments of the RV with hypercontractility of the basal segments. The left ventricular ejection fraction was preserved and no regional wall motion abnormalities were noted. An echocardiogram performed two months later showed resolution of RV wall motion abnormalities. A defibrillator was placed for secondary prevention of sudden cardiac death. The patient was readmitted with similar symptoms and with similar RV apical ballooning on echocardiography which resolved after 48 hours. Cardiac catheterization showed no obstructive coronary artery disease and normal hemodynamics. Further work up of the patient’s aspiration revealed elevated pressures of the upper and lower esophageal sphincters suggestive of increased vagal tone.

CONCLUSIONS: The exact mechanism of TC remains unknown. Proposed mechanisms include neurogenic “stunning” of the myocardium caused by acute cardiac autonomic dysfunction. The echocardiographic presentation of TC and its variants may be related to differences in regional sympathetic innervation and catecholamine receptor density in the myocardium in the setting of autonomic dysfunction. Our patient had a history of longstanding diabetes which may have predisposed him to dysautonomia as evidenced by episodes of bradycardia and remarkably elevated upper and lower esophageal sphincter pressures. So far, this is the first case of recurrent isolated RV stress-induced cardiomyopathy.

CLINICAL IMPLICATIONS: Patients with autonomic dysfunction may be at risk for takotsubo cardiomyopathy.

DISCLOSURE: The following authors have nothing to disclose: Joanna Paula Sta. Cruz, Jose Codolosa

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