Bei QT-Intervall-Verlängerung im EKG-Verlauf bei Takotsubo-Kardiomyopathie droht prädisponierten Patienten eine Torsade de pointes

Abstract

We report the case of a female patient with congenital complete atrioventricular block who developed torsade de pointes (TdP) in the course of takotsubo cardiomyopathy. On the basis of this case, we show that the electrocardiographic evolutionary changes with QT interval prolongation (in the course of takotsubo cardiomyopathy) may be a TdP threatening period in patients with underlying predispositions. After reviewing the literature, we also present the electrocardiographic similarities between takotsubo cardiomyopathy and other acute heart diseases associated with a large amount of stunned myocardium, i.e., other stress-related cardiomyopathies (e.g., those associated with subarachnoid hemorrhage, pheochromocytoma, or severe illnesses) as well as a reperfused myocardial infarction. QT interval prolongation is a common feature in the subacute phase of these entities; however, excessive QT prolongation may be a sign of predisposition to TdP. In such instances, measures should be taken to monitor cardiac rhythm closely and to prevent or treat TdP appropriately. Taking into account the risk of TdP, it is reasonable to consider takotsubo cardiomyopathy as a potential cause of acquired long QT syndrome.

Impact of Pheochromocytoma on Left Ventricular Hypertrophy and QTc Prolongation: Comparison with Takotsubo Cardiomyopathy

“…Several cases have reported that QT interval prolongation could be related to pheochromocytoma,5)6)7) and we also experienced a 48-year-old pheochromocytoma woman with marked QT interval prolongation (Fig. 1A) that progressed to torsades de pointes (Fig.…”

“…Electrocardiographic abnormalities that include rhythm, conduction and repolarization may occur in patients with pheochormocytoma. 25) 26) Several cases have reported that QT interval prolongation could be related to pheochromocytoma, 5) 6) 7) and we also experienced a 48-year-old pheochromocytoma woman with marked QT interval prolongation ( Fig. 1A ) that progressed to torsades de pointes ( Fig.…”

“…Although QTc interval prolongation in pheochromocytoma is rare, it has been reported in several cases, and it has been proposed that catecholamine excess may contribute to its development. 5) 6) 7) Recently, more attention has been given to the increasing number of cases of Takotsubo cardiomyopathy (TC). 8) 9) The relationship between TC and abnormal repolarization has been well-documented, which is probably because systolic dysfunction is associated with both TC and QT-interval prolongation.…”

Ventricular fibrillation during carotid endarterectomy and bailout stenting: a case report

“…Takotsubo cardiomyopathy is another candidate because it can prolong QT and cause TdP [ 10 ]. The suggested mechanism of QT elongation in Takotsubo cardiomyopathy is catecholamine or autonomic effects on the myocardium.…”

A case of pheochromocytoma presenting as syncope due to long QT syndrome

“…23 Several cases in literature have reported the relation of QT interval prolongation with pheochromocytoma. [24][25][26] Electrocardiographic abnormalities including rhythm, conduction and repolarization can occur in patients with pheochormocytoma. 27,28 They include marked prolongation of the Q-T interval and deep and wide symmetrically inverted T waves that are observed in 15% patients.…”