Life-threatening Takotsubo Cardiomyopathy.
OBJECTIVE
To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.


METHODS
A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.


RESULTS
The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.


CONCLUSIONS
Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.
Attending Physician, Pulmonary Medicine and Critical Care, Queens Hospital Center, Jamaica and Assistant Professor of Medicine, Mount Sinai School of Medicine, New York.
Karen
K
Mrejen-Shakin
Section Head of Critical Care, Queens Hospital Center, Jamaica and Assistant Professor of Medicine, Mount Sinai School of Medicine, New York.
Ricardo
R
Lopez
Attending Cardiologist, Queens Hospital Center, Jamaica and Mount Sinai School of Medicine, New York, Division of Cardiology, Queens Hospital Center (B 236) and Mount Sinai School of Medicine, 82-68 164th Street, Jamaica, NY 11452. E: shenoym@nychhc.org.
Mohandas M
MM
Shenoy