A Case of Takotsubo Cardiomyopathy in a Young Female with Infective Endocarditis

Abstract

Takotsubo cardiomyopathy is a clinical syndrome characterized by chest pain, transient left ventricular dysfunction, and specific electrocardiographic changes induced by physical or emotional stress. We describe a rare case of this syndrome associated with acute mitral valve bacterial endocarditis in a young female.

Case report: takotsubo syndrome in infectious endocarditis

“…Septic embolism, a sign of uncontrolled infection, affects the patients' prognosis and presents a common cause for surgery in IE [1]. In three of the four reported patients, cerebral and abdominal imaging was performed, showing embolic events affecting the brain, spleen and kidney [12,13]. Hence, self-limiting embolic cardiac infarction, even if unlikely, cannot be ruled out as an explanation for apical left ventricular dysfunction.…”

“…Besides from the presented case of concomitant TTS and IE, only three other cases have been reported, all affecting the mitral valve [ 11 – 13 ]. While in these cases, triggers other than IE such as previous surgical treatment, severe mitral valve regurgitation and meningitis might have contributed to TTS development, in our case, despite a time-to-diagnosis of 30 days, there were no other TTS triggers besides from severe IE with embolic events [ 11 – 13 ]. Previous studies showed that in about 15% of cases of IE, the initial TEE is negative, especially in the presence of pre-existent lesions, such as prosthetic valves [ 14 ].…”

“…As previously stated, TTS has been associated with central nervous system disorders involving regions responsible for emotional processing [ 2 – 5 ]. Thus, it is noteworthy to mention that in the patients who received cerebral imaging cerebral embolisms were detected, amongst others affecting the temporal lobe [ 12 , 13 ]. Therefore, it is conceivable that cerebral embolisms caused by IE might precede TTS development.…”

“…Interestingly, the presence of TTS was not associated with a higher in-hospital mortality [ 15 ]. Similarly, all four patients with TTS and concomitant IE were female and had a favorable outcome [ 11 – 13 ]. All received antibiotic as well as surgical treatment.…”

“…All received antibiotic as well as surgical treatment. In three cases, the affected valve was replaced while in one the native valve was reconstructed [ 11 – 13 ]. As a consequence, TTS in IE patients might not worsen the patients’ prognosis if IE is treated sufficiently.…”