title: Stress Cardiomyopathy Caused by Diving: Case Report and Review of the Literature.
abstract: BACKGROUND
  Stress cardiomyopathy is characterized by transient myocardial dysfunction that mimics a myocardial infarction in the absence of obstructive coronary artery disease. The onset is frequently triggered by an acute illness or intense physical or emotional stress.
  
  
  METHODS
  We describe the case of a 47-year-old woman who was brought to the emergency department with acute onset shortness of breath while scuba diving. She was found to have acute pulmonary edema radiographically. Her troponins were noted to be positive. Initial echocardiogram showed basal hypokinesis with hyperkinesis of apex. She was treated with noninvasive ventilation and intravenous diuretic therapy and her symptoms significantly improved. She subsequently underwent cardiac catheterization which revealed nonobstructive coronary artery disease. An exercise stress echocardiogram was performed 2 days later that revealed resolution of the wall motion abnormality and no ischemia at high levels of exercise. A diagnosis of reverse stress (Takotsubo) cardiomyopathy was made based on Mayo Clinic Diagnostic criteria. ​WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case brings to light the risk of stress cardiomyopathy in divers. The diagnosis should be considered in patients presenting with acute pulmonary edema during diving.
authors.affiliation: Cardiology Division, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Aurangzeb
authors.initials: A
authors.lastname: Baber
authors.affiliation: Cardiology Division, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Sanjeev U
authors.initials: SU
authors.lastname: Nair
authors.affiliation: Cardiology Division, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Sumit
authors.initials: S
authors.lastname: Duggal
authors.affiliation: Cardiology Division, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Salman
authors.initials: S
authors.lastname: Bhatti
authors.affiliation: Cardiology Division, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Sundlof
mesh_terms: D000208:Acute Disease; D001007:Anxiety / Q000209:etiology; D004242:Diving / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D054549:Takotsubo Cardiomyopathy / Q000209:etiology*
keywords: acute coronary syndrome; cardiomyopathy; diving; pulmonary edema; stress; stress-induced cardiomyopathy