title: Takotsubo cardiomyopathy induced by suicidal neck hanging.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TC) is an uncommon immune-endocrinologic cause of acute reversible heart failure, generally caused by some form of stress.
  
  
  METHODS
  We report a case of TC after hanging for attempted suicide. Upon admission, the patient demonstrated an almost entirely normal electrocardiogram (ECG) and mild hypotension. However, on the third day after hanging, she developed chest and back pain with inverted T waves and QTc prolongation on ECG. Her coronary arteries were normal on angiogram, but the left ventricle showed apical ballooning, consistent with TC. She was treated with an intra-aortic balloon pump and fully recovered. We observed that the QTc interval seemed to be a good guide for clinical course in this case. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TC should be considered in any acute stressful presentation, and to assist in the diagnosis as TC, we suggest following the QTc on ECG. TC should be taken into consideration in patients after suicide attempt with low blood pressure or an abnormal ECG, including ST segment elevation, T wave inversion, and QTc prolongation.
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Sawamoto
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hase
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Uemura
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Eichi
authors.initials: E
authors.lastname: Narimatsu
mesh_terms: D001237:Asphyxia / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009333:Neck; D013406:Suicide, Attempted; D054549:Takotsubo Cardiomyopathy / Q000209:etiology*
keywords: apical balloon syndrome; neck hanging; suicide; takotsubo cardiomyopathy