Cardiovascular Disease: Student/Resident Case Report Poster - Cardiovascular Disease I |

A Broken Heart Completely Blocked FREE TO VIEW

Tanvir Kahlon, MD; Ryan Jamoua, MD; Antonious Attallah, MD
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St. John Hopital Medical Center, Royal Oak, MI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):84A. doi:10.1016/j.chest.2016.08.092
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SESSION TITLE: Student/Resident Case Report Poster - Cardiovascular Disease I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Takotsubo cardiomyopathy (TCM) is a rare cause of acute onset, transient cardiac dysfunction mimicking acute coronary syndromes (ACS). It usually presents itself in postmenopausal women undergoing acute emotional or physical stress, and manifests itself as ST elevation on ECG, and elevated troponin levels. We present a case of complete heart block as presentation of TCM in an elderly male.

CASE PRESENTATION: Patient is an 84-year-old male with past medical history of hypertension, and remote history of adenocarcinoma of colon status post resection, and radiation, who presents with one-month history of progressive, exertional dyspnea, and orthopnea. He experienced occasional episodes of lightheadedness during this time but denied any syncopal event. He denied any palpitations, chest pain, nausea, emesis, or diaphoresis. On arrival, patient was noted to be in acute hypoxic respiratory failure. He had a heart rate of 44 with otherwise normal vital signs. Rest of the physical exam was found to be unremarkable. Complete heart block was noted on ECG. Significant lab findings included troponin of 0.21 ng/ml and pro-BNP of 9121 pg/ml. Stat echocardiogram showed an acute reduction in left ventricular ejection fraction of 30-35%, a severely hypokinetic apex, with preservation of the rest of the segments. Patient was taken for emergent coronary catheterization, which showed non-obstructive coronaries and findings consistent with TCM. Patient underwent pacemaker placement and was discharged 2 days later.

DISCUSSION: Complete heart block is a rare presentation of TCM. Only a few cases have been reported in literature. Pathophysiology behind TCM is not well understood, but it is postulated that a stress induced sympathetic response is responsible for coronary vasospasm causing acute, reversible cardiac dysfunction. Cases of TCM presenting with high degree heart block, while show improvement in ejection fraction, rarely show reversal of conduction abnormalities. Given the rarity of the condition, it is unclear whether stress of symptomatic conduction abnormalities leads to TCM or TCM, itself, causes the conduction abnormality.

CONCLUSIONS: Takotsubo cardiomyopathy is a rare but reversible etiology of cardiac dysfunction. High degree heart block associated with this condition has shown persistence despite resolution of left ventricular dysfunction. Identifying complete heart block in takotsubo cardiomyopathy is essential as it impacts long term management of these patients.

Reference #1: Korantzopoulos, P., Nikas, D., Letsas, K., Gkirdis, I., Kolios, M., Ntalas, I., Goudevenos, J. High grade atrioventricular block and takotsubo cardiomyopathy: Case report and review of literature. Int Cardiovasc Res J. 2015; 9(2): 119-124.

Reference #2: Shanmugasundaram, R., Tamilarasu. K., Rajendiran, G., Murali, A. An uncommon presentation of a rare disease: High degree AV block with takotsubo cardiomyopathy. Indian Heart Journal. 2012; 64: 511-514.

DISCLOSURE: The following authors have nothing to disclose: Tanvir Kahlon, Ryan Jamoua, Antonious Attallah

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