Down on your luck: cardiomyopathy precipitated by a bar fight

Abstract

Takotsubo cardiomyopathy is characterized by transient loss of systolic function in the absence of coronary artery disease. It is significantly more common in post-menopausal women and is typically brought on by intense emotional stress. Pathophysiology is not completely elucidated, but it appears to be related, in part, to excess catecholamine; this results in coronary artery vasospasm, ischemia and eventual ventricular dysfunction. Patient presentation can vary widely, but typically presents similar to acute coronary syndrome. Management involves acute stabilization and monitoring, as well as guideline-directed medical therapy for heart failure. We report a very unique case of a healthy male patient presenting with nonanginal symptoms of racing heart, who was found to have cardiomyopathy following a physical encounter. This case serves to bring into awareness that intense physical encounters may be sufficient to induce cardiomyopathy without presenting angina.

Oxidative Stress in Takotsubo Syndrome—Is It Essential for an Acute Attack? Indirect Evidences Support Multisite Impact Including the Calcium Overload—Energy Failure Hypothesis

“…Alcohol consumption reduces the level of GSH and alters antioxidant protection ( 125 ). An acute TTS has been described in a 50-year-old man attacked in front of a bar; the level of ethanol in the blood at the time of examination was 400 mg/L ( 126 ).…”