title: Sudden cardiac death secondary to demonstrated reperfusion ventricular fibrillation in a woman with Takotsubo cardiomyopathy.
abstract: Takotsubo cardiomyopathy is a left ventricle cardiomyopathy characterized by a reversible dyskinesia responsible for the typical apical ballooning aspect. The disease is considered benignant with a full recovery within a few weeks. We present the case of a 52-year-old woman who presented with angina diagnosed with Takotsubo cardiomyopathy on the basis of both noninvasive (electrocardiography, echocardiography) and invasive (angiography) exams. At discharge, a Holter monitor was fitted to the patient. During the recording the patient faced sudden cardiac death. The analysis of the Holter traces allowed some speculations on the mechanism of this unexpected arrhythmic death. The cause of the fatal ventricular fibrillation appears to be the fast reperfusion following a short occlusion of an epicardial coronary artery. This case highlights the epicardial vasospasm as an important pathogenic mechanism of the syndrome and the possible usefulness of diagnostic tests able to elicit the spasm susceptibility and guide a more targeted pharmacological therapy. Some considerations are also possible on the cellular processes linking the rapid reperfusion and the arrhythmias onset.
authors: Cardiology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy. drmartinopepe@libero.it
authors: Martino
authors: M
authors: Pepe
authors: Domenico
authors: D
authors: Zanna
authors: Donato
authors: D
authors: Quagliara
authors: Carlo
authors: C
authors: Caiati
authors: Andrea
authors: A
authors: Marzullo
authors: Angela I
authors: AI
authors: Palmiotto
authors: Gilda
authors: G
authors: Caruso
authors: Stefano
authors: S
authors: Favale
mesh_terms: D016757:Death, Sudden, Cardiac / Q000209:etiology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000150:complications / Q000175:diagnosis; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology