title: A case of apical ballooning syndrome in a male with status asthmaticus; highlighting the role of B2 agonists in the pathophysiology of a reversible cardiomyopathy.
abstract: Apical ballooning syndrome (ABS), also known as Takotsubo cardiomyopathy, was first reported by Dote and colleagues in Japanese literature in 1991 in a review of five cases. Case series have highlighted the association of severe psychological stressors as the major precipitating factors of this syndrome. Status Epilepticus and Sub-Arachnoid hemorrhage are also now established independent etiologies for this phenomenon in patients without coronary artery disease. We report a case of reversible apical ventricular dysfunction in a 50-year-old male presenting with status asthmaticus who quickly underwent intubation. Following this, he had ST elevations in precordial leads with mild cardiac enzyme leak. Subsequent cardiac catheterization revealed a left ventricular ejection fraction of 25-30% with apical aneurismal segment. No obstructive disease was observed. Three days later there was marked clinical improvement; the patient was extubated and repeat echocardiography revealed a remarkable return to normal ventricular size and systolic function. Our case demonstrates that excess use of beta-agonists may be a potential risk factor for ABS and raises the possibility of cathecholamine cardiotoxicity being mediated via beta-receptors. Furthermore, it also negates the propensity of apical ballooning so far reported only in women with respiratory distress without confounding emotional stressors.
authors.affiliation: Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.
authors.forename: Farah F
authors.initials: FF
authors.lastname: Salahuddin
authors.forename: Peter
authors.initials: P
authors.lastname: Sloane
authors.forename: Philip
authors.initials: P
authors.lastname: Buescher
authors.forename: Lev
authors.initials: L
authors.lastname: Agarunov
authors.forename: Divya
authors.initials: D
authors.lastname: Sreeramoju
keywords: cardiology; medicine; pulmonary critical care