A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma

Abstract

Takotsubo cardiomyopathy is a rare syndrome of transient, reversible left ventricular systolic dysfunction. It mimics myocardial infarction clinically and includes elevated cardiac enzymes, but echocardiography reveals apical ballooning and basal hyperkinesis. Infrequently, midventricular or even reverse Takotsubo patterns have been described, involving ballooning of the basal heart without the characteristic ‘Takotsubo’ appearance. There are cases in the literature that support a connection between reverse Takotsubo cardiomyopathy (r-TTC) and neurological insults as inciting factors. We report a case of r-TTC in an otherwise healthy 23-year-old man presenting with back pain, urinary retention, bradycardia, and hypertension. Troponin levels and brain natriuretic peptide (BNP) were elevated, and echocardiogram revealed an ejection fraction (EF) of less than 20%. In addition, MRI demonstrated a spinal subdural hematoma from T1-S1 with no cord compression. Repeated echocardiogram demonstrated an EF of 20-25% with a reverse Takotsubo pattern of cardiomyopathy. With supportive care, his clinical picture improved with normalization of cardiac enzyme and BNP values. This case represents a r-TTC presenting as heart failure in a young, apparently healthy male likely incited by a spinal subdural hematoma. To our knowledge, it is the first of its kind reported.

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review

“…We have searched the EMBASE, PubMed, CNKI, and Web of Science databases using the terms ‘spinal subdural hematoma and (heart or Takotsubo)’ and identified only two reported cases of acute heart failure induced by SSDH before March 2022 ( 13 , 14 ). The clinical profiles of these cases, including publication year, patient’ age/sex, hematoma location, cause of bleeding, elevation of cTNI and BNP, treatment, follow-up duration, and outcome were summarized in Table 1 .…”

TakoTsubo Syndrome: First an Acute Coronary Vasculitis and Then Prolonged Myocarditis?

“…It is feasible but unproved that incremental sympathetic discharge and catecholamine release, documented in the early stages of TTS [38], might tend to provoke ischemia via induction of microvascular constriction and increases in myocardial work. Indeed, hypertension has occasionally been reported in the early stages of TTS [39]. However, surges in catecholamine release contribute both to redox stress and to glycocalyx "shedding", with associated fluid and leukocyte extravasation [40].…”

(Reverse Takotsubo syndrome, a rare form of "Broken Heart" syndrome)

“…13,14 V literatuře byly popsány některé zajímavé případy jako iatrogenní vznik rTTS po 70násobně vyšší aplikaci noradrenalinu v kontinuální infuzi při poškození injektorové pumpy, rTTS po dobutaminové zátěžové echokardiografi i, postpartální srdeční selhání způsobené rTTS, rTTS u spinálního subdurálního hematomu, po předávkování amfetaminem a případ pacientky s klasickou formou TTS a reverzní formou TTS v průběhu jednoho roku. [17][18][19][20][21][22] V diagnostice tohoto syndromu nesmíme zapomínat na pečlivý odběr anamnézy v předchorobí, s udávanou stresovou psychickou či fyzickou situací. Subjektivně mají pacienti zejména bolesti na hrudi imitující typické stenokardie, palpitace, dušnost, klinicky známky srdečního selhání, ale první manifestací může být i synkopa při maligní arytmii či rozvoj kardiogenního šoku.…”