title: Clostridium Difficile Infection and Takotsubo Cardiomyopathy: Is There a Relation?
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TCM) mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. It is a transient condition that typically precedes physical or emotional triggers.
  
  
  METHODS
  We describe the case of a 65-year-old woman who presented to our institution with symptomatic Clostridium difficile infection. 24 hours after admission, the patient complained of severe, retrosternal chest pain. Electrocardiogram showed diffuse elevation of ST-segment in the chest leads; however, coronary angiography demonstrated normal coronary arteries. Therein, an echocardiography was performed, which revealed apical ballooning and hypercontractile base with global left ventricular hypokinesis. These features were consistent with TCM. The patient was managed conservatively. Repeat echocardiogram 2 weeks later showed resolution of heart failure.
  
  
  CONCLUSIONS
  To our research, this is the first report of TCM caused by C. difficile infection. Clinicians involved in the care of patients with C. difficile infection must be aware of this complication and should consider TCM in those who develop atypical chest pain.
authors: Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York City, New York, USA.
authors: Hafeez Ul Hassan
authors: HU
authors: Virk
authors: Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, New York, USA.
authors: Faisal
authors: F
authors: Inayat
keywords: Apical ballooning; Clostridium difficile; coronary artery disease; takotsubo cardiomyopathy