title: Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TC) is described as transient ventricular dysfunction following emotional or physical trauma. A few reports have described patients with TC in association with various circumstances of thyrotoxicosis. We report an unusual case of TC in a patient with a large retrosternal goiter and normal thyroid function. We speculate that TC was triggered by compromise of tracheal flow induced by the goiter.
  
  
  METHODS
  A 68-yr-old woman without primary heart disease presented with cardiorespiratory collapse requiring ventilatory and cardiovascular support, including placement of an intra-aortic balloon pump. She was diagnosed with a severe form of TC based on characteristic echocardiography findings and clinical course. Within less than a week, her myocardial function completely normalized. The patient was later found to have a large retrosternal goiter compressing her trachea, though her thyroid function was normal. A total thyroidectomy was eventually performed, and she made a full recovery. Subsequently, the patient was found to have a positive JAK2 mutation for a myeloproliferative disorder.
  
  
  CONCLUSIONS
  Takotsubo cardiomyopathy may be regarded as the final common pathway of cardiac dysfunction triggered by various stress conditions, in this case, a large retrosternal goiter not associated with thyrotoxicosis and likely exacerbated by severe leukocytosis related to a myeloproliferative disorder.
authors.affiliation: Department of Anesthesia and Critical Care, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Avenue West S5.05, Montreal, QC, H3A 1A1, Canada. roupenhatz@hotmail.com
authors.forename: Roupen
authors.initials: R
authors.lastname: Hatzakorzian
authors.forename: Helen
authors.initials: H
authors.lastname: Bui
authors.forename: Thomas
authors.initials: T
authors.lastname: Schricker
authors.forename: Steven B
authors.initials: SB
authors.lastname: Backman
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006044:Goiter, Nodular / Q000150:complications*; D006045:Goiter, Substernal / Q000150:complications*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D053614:Janus Kinase 2 / Q000235:genetics; D009154:Mutation / Q000235:genetics; D009196:Myeloproliferative Disorders / Q000175:diagnosis / Q000235:genetics; D010649:Phenylalanine / Q000235:genetics; D012131:Respiratory Insufficiency / Q000209:etiology; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D014135:Tracheal Stenosis / Q000209:etiology; D014633:Valine / Q000235:genetics
chemical_list: D010649:Phenylalanine; C507924:JAK2 protein, human; D053614:Janus Kinase 2; D014633:Valine