Angry bowels breaking hearts: a case series

Abstract

Stress cardiomyopathy or Takotsubo cardiomyopathy (TCM) is transient left ventricular apical akinesis in the absence of angiographic evidence of corresponding obstructive coronary artery disease. A classic presentation is of chest pain following intense emotional or physical stress. Reports of stress-inducing triggers include acute respiratory failure, sudden death of a loved one, sympathomimetic drugs, pheochromocytoma crisis, diabetic ketoacidosis, and even earthquakes. We report three cases of intra-abdominal etiologies precipitating Takotsubo cardiomyopathy: two with small bowel obstruction, and one with Clostridium difficile colitis.

Gut Feelings and Broken Hearts: A Case of Small Bowel Obstruction Causing Takotsubo Cardiomyopathy

“…Upon literature review, we identified only three other cases of small bowel obstruction induced TCM. In 2018, Soliman et al [6] reported two cases of takotsubo cardiomyopathy that developed after small bowel obstruction and were managed conservatively with bowel rest and pain control. In both cases, the patient's subsequent echocardiography showed substantially improved ejection fractions.…”

“…Though rare, there are cases of patients presenting with abdominal pain complicated by TCM [6][7][8][9]. Accurate and prompt diagnosis has substantial prognostic implications in view of the evidence that, in TCM patients, the underlying critical illness is the main driver of mortality rates [10].…”