Tako-tsubo cardiomyopathy observed in a patient with sepsis and transient hyperthyroidism.
A 55-years-old woman, with a history of hypertension and ischemic stroke with residual left hemiparesis, was admitted to our hospital because of dyspnoea with clinical evidence of acute pulmonary edema. She was found to have a sinus tachycardia with ST-elevation in leads D1, aVL and V1-V4 in the electrocardiogram, and akinesis of the left ventricular apex with overall left ventricular systolic function being severely impaired and an ejection fraction of 28% on echocardiography. Orotracheal intubation was performed and mechanical ventilation was immediately started. Emergency cardiac catheterization was performed 2 h after the symptom onset. Coronary angiography showed no significant coronary artery disease. Blood analysis revealed an increase in the creatine kinase MB fraction, a significant positive detection in troponin T, a white blood cell count of 35000 per microliter, C-reactive protein of 59,9 mg/dl, and transient elevation in the concentration of free triiodothyronine, free thyroxine, thyroid globulin antibody, and thyroid peroxidase antibody. The symptoms improved during the next days, and follow-up echocardiography 18 days later showed complete resolution of the left ventricular dysfunction. These data suggest that tako-tsubo cardiomyopathy may be induced in patients with sepsis and transient hyperthyroidism.
Sarullo
Filippo M
FM
Division of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy. fsarullo@neomedia.it
Americo
Luigi
L
Accardo
Salvatore
S
Cicero
Sergio
S
Schicchi
Rossella
R
Schirò
Maria
M
Castello
Antonio
A
D017311:Amlodipine / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008713:Methimazole / Q000627:therapeutic use; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D017257:Ramipril / Q000627:therapeutic use; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis*
D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D013956:Antithyroid Agents; D005938:Glucocorticoids; D010975:Platelet Aggregation Inhibitors; D017311:Amlodipine; D008713:Methimazole; D011433:Propranolol; D015242:Ofloxacin; D017257:Ramipril; D001241:Aspirin; D011241:Prednisone