Unraveling the Enigma: A Case of Reverse Takotsubo Syndrome With Cardiogenic Shock

Document Type

Conference Proceeding

Publication Date

4-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Acute coronary syndrome symptoms in patients can stem from various causes. Timely utilization of imaging modalities such as echocardiograms is crucial for early and accurate diagnosis. Case: A 27-year-old male, with an unremarkable medical history, presented at a critical access facility with complaints of nausea, vomiting, and shortness of breath. Initial investigations revealed elevated troponin levels and acute T wave abnormalities. Subsequent cardiac catheterization showed unremarkable coronaries. An echocardiogram confirmed reverse Takotsubo syndrome. As the patient’s symptoms persisted and worsened, he progressed to cardiogenic shock necessitating Impella circulatory support. Following Impella placement, hewas transferred to a higher care facility. Although evaluation for VV ECMO was deferred initially, the patient’s condition improved after a few days. A subsequent echocardiogram demonstrated complete resolution of reverse Takotsubo findings. The patient still required renal and respiratory support through CRRT and ventilator assistance, respectively. Decision-making: Takotsubo cardiomyopathy manifests as reversible left ventricular dysfunction induced by surges of catecholamines due to physical or emotional stress. Reverse Takotsubo, a rare variant seen in around 2% of troponin-positive patients with suspected ACS, often presents in younger individuals and is linked to neurological disorders. While its exact mechanism isn’t fully understood, it’s believed to result from catecholamine-induced cardiotoxicity, leading to microvascular impairment or coronary artery spasms. Patients typically exhibit classical ACS symptoms alongside LV basal hypokinesis/akinesis and hyperdynamic apex changes, as revealed by echocardiography. Conclusion: Swift identification of Takotsubo syndrome is pivotal for early intervention. Patients often require Impella support and, occasionally, VV ECMO. Timely initiation of these interventions significantly enhances patient outcomes.

Volume

83

Issue

13 Suppl

First Page

3155

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05145-3

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