J Cardiovasc Ultrasound.  2016 Mar;24(1):79-83. 10.4250/jcu.2016.24.1.79.

Stress-Induced Cardiomyopathy Presenting as Shock

• Yoo TK
• Lee JY
• Sung KC
• Oh SS
• Song YS
• Lee SJ
• Ko KJ

• KMID: 2161002
• DOI: http://doi.org/10.4250/jcu.2016.24.1.79

Abstract

Stress-induced cardiomyopathy has become a more recognized and reported entity. It can be caused by emotional or physical stress, which causes excessive catecholamine release. Typically, the clinical course is benign with conservative treatment being effective. However, stress-induced cardiomyopathy can be fatal. A 41-year-old female presented with cardiogenic shock followed by sudden back pain. Initial echocardiographic finding showed severely decreased ejection fraction with akinesia at all mid-to-apical walls with relatively preserved basal wall contractility. The coronary artery was intact on coronary angiography. Cardiac resuscitation and extra-corporeal membrane oxygenation was needed to manage the cardiogenic shock. Recovery was complete after 2 weeks.

Keyword

Takotsubo cardiomyopathy; Extracorporeal membrane oxygenation; Shock; Cardiogenic; Echocardiography

MeSH Terms

Adult
Back Pain
Cardiomyopathies*
Coronary Angiography
Coronary Vessels
Echocardiography
Extracorporeal Membrane Oxygenation
Female
Humans
Membranes
Oxygen
Resuscitation
Shock*
Shock, Cardiogenic
Takotsubo Cardiomyopathy
Oxygen

Figure

• 

  Fig. 1 Electrocardiographic findings revealed sinus tachycardia with ST segment elevation in precordial leads at initial admission (A) and normalized ST segment on follow up electrocardiogram at 1 month after discharge (B).

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  Fig. 2 Transthoracic echocardiography, parasternal long axis view (A at diastolic period, B at systolic period), and apical 4-chamber view (C at diastolic period, D at systolic period), showed dilated cavity, akinesia at all mid to apical left ventricular (LV) walls and relatively preserved contractility in basal walls, with severe LV systolic dysfunction (estimated LV ejection fraction, 15–20%) (B).

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  Fig. 3 Coronary angiography showing normal coronary arteries, without significant stenosis. LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery.

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  Fig. 4 Cardiac magnetic resonance imaging showing no evidence of LV wall motion abnormality on white blood cine image (A), myocardial perfusion defect in gadolinium-based contrast enhanced first-pass perfusion image (B). There was no evidence of delayed enhancement of LV myocardium (C). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

Reference

1. Wan SH, Liang JJ. Takotsubo cardiomyopathy: etiology, diagnosis, and optimal management. Res Rep Clin Cardiol. 2014; 5:297–303.

2. Cesário V, Loureiro MJ, Pereira H. [Takotsubo cardiomyopathy in a cardiology department]. Rev Port Cardiol. 2012; 31:603–608.

3. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008; 118:397–409.

4. Boland TA, Lee VH, Bleck TP. Stress-induced cardiomyopathy. Crit Care Med. 2015; 43:686–693.

5. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015; 373:929–938.

6. Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of takotsubo cardiomyopathy in the United States. Am Heart J. 2012; 164:66–71.e1.

7. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008; 118:2754–2762.

8. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141:858–865.

9. Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005; 111:472–479.

10. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I. Angina Pectoris-Myocardial Infarction Investigations in Japan. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina pectoris-myocardial infarction investigations in Japan. J Am Coll Cardiol. 2001; 38:11–18.

11. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155:408–417.

12. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011; 306:277–286.

13. Wagner A, Schulz-Menger J, Dietz R, Friedrich MG. Long-term follow-up of patients paragraph sign with acute myocarditis by magnetic paragraph sign resonance imaging. MAGMA. 2003; 16:17–20.