Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Abstract

Takotsubo cardiomyopathy or stress cardiomyopathy is a transient reversible cardiomyopathy characterized by regional wall motion abnormalities that usually extend beyond a single epicardial vascular distribution. It is often precipitated by acute physical or emotional stressors. In this article, we present the case of a postmenopausal woman who was admitted for management of acute pancreatitis. On the second day of admission, she developed shortness of breath and electrocardiographic abnormalities. A transthoracic echocardiogram revealed left ventricular systolic dysfunction and apical akinesis, and coronary angiography revealed normal coronary arteries. She was diagnosed with takotsubo cardiomyopathy triggered by acute pancreatitis and started on guideline-directed heart failure medications. A follow-up echocardiogram 4 months later revealed persistent systolic dysfunction and apical akinesis.

Takotsubo Cardiomyopathy Triggered by Acute Pancreatitis: A Case Report

“…Acute pancreatitis not only induces a systematic inflammation response, but also is a significant physical stressor which triggers the release of catecholamines. This, in turn, can either have a direct toxic effect on the cardiac myocytes, or lead to an indirect damage by causing multivessel spasm in predisposed individuals [7]. It has been proposed that regional differences in catecholamine-induced vasocontraction, innervation, and adrenergic sensitivity might be the cause of the mechanism of the regional difference in contractility [8].…”

Takotsubo cardiomyopathy complicating acute pancreatitis: a case report

“…All patients, where treatments were described, were discharged on a beta-blocker and ACEi, and in those whose follow-up was reported, all but one had recovered left ventricular function, ranging from as early as 10 days up to 6 weeks. Abe et al [ 4 ] reported the case of persistently reduced left ventricular function even at 4 months, which was hypothesised to be due to ongoing alcohol use (Table 1 ).…”