Apical ballooning syndrome after attempted suicidal hanging

Abstract

We report a case of “Apical Ballooning Syndrome” following attempted suicidal hanging. Our patient developed retrosternal chest pain and ischemic changes on electrocardiography (ECG), a day after the suicidal attempt. She underwent an angiogram considering the possibility of acute coronary syndrome. However, her coronary arteries were normal; the left ventricle showed the typical ballooning pattern characterized by hypokinesia of the distal septum and apex. On follow-up a week later, she remained asymptomatic; her ECG changes had reversed and the left ventricular contractility was normal on echocardiography.

A case of "Tako-Tsubo syndrome" with postoperative shock

“…[2] Usually, the reported patients were conscious, oriented, and complained of chest pain. However, our situation was different.…”

“…Some direct cardiomyocytes modulating effects of catecholamines have been proposed as a pathophysiology of TTS. [ 2 ] The apex may be more vulnerable to excessive sympathetic stimulation (especially epinephrine) due to presence of more and more b2 adrenergic receptor in apical region of the heart. [ 4 ] One newly proposed transient mid-left ventricular cavity dynamic gradient mechanism[ 5 ] was applied in our patient.…”

“…It is associated with extreme physical or emotional stress with marked female predilection, especially postmenopausal. [ 2 3 ] We herein report a case of TTS in a 61-year-old woman following elective laparoscopic surgery and postoperative septic shock. To the best of our knowledge and literature search, we could not find any case report of TTS with shock.…”

Post Obstructive Pulmonary Edema After Attempted Nylon Rope Suicidal Hanging

“…(7) Though the pathogenesis of pulmonary edema appear to be multifactorial, in our case but the primary factor being markedly negative intrapleural pressure associated with upper airway obstruction. (8) In our patient it appears that attempted hanging with nylon rope caused severe degree of mechanical airway obstruction, attempts at breathing against it led to severe degree of negative intrapleural pressure resulting in post obstructive pulmonary edema. Our patient remained heamodynamically stable throughout, and there were no ECG changes suggestive of any ventricular hypokinesia as was observed in another case report.…”

Inverted Takotsubo cardiomyopathy: A rare entity often missed!

“…The type of TTC that occurs in suicidal hanging is not restricted to the inverted variant. The classic variant has also been previously described following attempted suicidal hanging 9 …”