title: Takotsubo cardiomyopathy: A known unknown foe of asthma.
abstract: BACKGROUND
  Patients with uncontrolled asthma are at a greater risk of asthma attacks requiring emergency room visits or hospital admissions. Takotsubo cardiomyopathy is potentially a significant complication in a course of status asthmaticus.
  
  
  METHODS
  We describe a 43-year-old female patient who presented with status asthmaticus that was further complicated with takotsubo cardiomyopathy.
  
  
  RESULTS
  Recognizing apical ballooning syndrome is challenging in patients with a history of respiratory disease because the symptoms of the last entity may complicate the diagnostic approach. It is difficult to distinguish clinically apical ballooning syndrome from the acute airway exacerbation itself. Both asthma and takotsubo cardiomyopathy share the same clinical presentation with dyspnea and chest tightness. In our patient, the electrocardiographic abnormalities, the rapidly reversible distinctive characteristics of echocardiography, and the modest elevation of serum cardiac biomarkers levels, in combination with the presence of a stress trigger (severe asthma attack), strongly supported the diagnosis of broken heart syndrome.
  
  
  CONCLUSIONS
  Clinicians should re-evaluate asthma management and be aware of the complications associated with asthma attacks such as stress-induced cardiomyopathy.
authors.affiliation: a Department of Respiratory Medicine , Faculty of Medicine, University Hospital of Larissa, University of Thessaly, BIOPOLIS , Larissa , Greece.
authors.forename: Ourania S
authors.initials: OS
authors.lastname: Kotsiou
authors.affiliation: b Department of Cardiology , General Hospital of Volos , Magnesia , Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Douras
authors.affiliation: c Department of Critical Care , University Hospital of Larissa, Faculty of Medicine, University of Thessaly, BIOPOLIS , Larissa , Greece.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Makris
authors.affiliation: b Department of Cardiology , General Hospital of Volos , Magnesia , Greece.
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Mpaka
authors.affiliation: a Department of Respiratory Medicine , Faculty of Medicine, University Hospital of Larissa, University of Thessaly, BIOPOLIS , Larissa , Greece.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Gourgoulianis
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications; D015415:Biomarkers; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D013224:Status Asthmaticus / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers
keywords: Apical ballooning syndrome; asthma attack; broken heart syndrome; cardiac biomarkers; status asthmaticus; stress-induced cardiomyopathy