title: Sepsis-Induced Takotsubo Cardiomyopathy Leading to Torsades de Pointes.
abstract: Background. Takotsubo cardiomyopathy (TCM) is sudden and reversible myocardial dysfunction often attributable to physical or emotional triggers. Case Report. We describe a 51-year-old man presented to emergency department with sepsis from urinary tract infection (UTI). He was placed on cefepime for UTI and non-ST-elevation myocardial infarction protocol given elevated troponins with chest pain. Subsequently, patient was pulseless with torsades de pointes (TdP) and then converted to sinus rhythm with cardioversion. An echocardiogram revealed low ejection fraction with hypokinesis of the apical wall. Over 48 hours, the patient was extubated and stable on 3 L/min nasal cannula. He underwent a cardiac catheterization to evaluate coronary artery disease (CAD) and was found to have mild nonobstructive CAD with no further findings. Conclusion. TCM is a rare disorder presenting with symptoms similar to acute coronary syndrome. Though traditionally elicited by physical and emotional triggers leading to transient left ventricular dysfunction, our case suggests that it may also be triggered by a urinary tract infection and lead to severe QT prolongation and a malignant ventricular arrhythmia in TdP.
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA; Department of Cardiology, VA NY Harbor Healthcare System, Brooklyn, NY 11209, USA.
authors.forename: Nirav
authors.identifier: 0000-0001-7797-7248
authors.initials: N
authors.lastname: Patel
authors.affiliation: College of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: Abhishek
authors.identifier: 0000-0002-9467-2873
authors.initials: A
authors.lastname: Shenoy
authors.affiliation: Department of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: George
authors.identifier: 0000-0002-8541-5162
authors.initials: G
authors.lastname: Dous
authors.affiliation: Department of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: Haroon
authors.initials: H
authors.lastname: Kamran
authors.affiliation: Department of Cardiology, VA NY Harbor Healthcare System, Brooklyn, NY 11209, USA; Department of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: El-Sherif