Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?

Abstract

Takotsubo cardiomyopathy (TCM) is a variant of stress-induced cardiomyopathy, characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 51-year-old Caucasian female with severe chronic obstructive pulmonary disease (COPD) who presented with syncope and was found to have her second lifetime episode of stress-induced cardiomyopathy. Eight months prior, she had been admitted with a COPD exacerbation and was found to have left ventricular (LV) dysfunction with ejection fraction (EF) of 22% attributed to TCM with subsequent normalization of her left ventricular function. Recurrence of stress-induced cardiomyopathy associated with COPD is a rare phenomenon and its presentation raises the possibility of a common underlying mechanism.

Utility of recognizing early electrocardiogram changes in bronchogenic Takotsubo cardiomyopathy: A case report

“…It has been widely suggested that a bronchogenic sub type of TCM exists[3]. Although not as common, there have been some reported cases of TCM in the setting of COPD or asthma[4,5]. Some authors even estimate that pulmonary pathologies are suspected to be found in as high as 44% of TCM cases[6], thus justifying the creation of a separate classification as a bronchogenic subtype.…”

“…Some authors even estimate that pulmonary pathologies are suspected to be found in as high as 44% of TCM cases[6], thus justifying the creation of a separate classification as a bronchogenic subtype. The disproportionate predominance of sympathetic activity during a COPD exacerbation has been noted as a possible trigger for TCM[4]. Rajwani et al[3] described 5 specific cases of bronchogenic TCM and noted some distinguishing features.…”

A Case of Recurrent Takotsubo Cardiomyopathy: Not a Benign Entity

“…Takotsubo cardiomyopathy has been found to be associated with physical and emotional triggers. Some of these stressors include pheochromocytoma, myocarditis, psychiatric illnesses, prolonged QT syndromes, COPD exacerbations, albuterol, hyperthyroidism, seizure disorders, electroconvulsive therapy, acute brain injury, and sepsis [6][7][8][9][10][11][12][13][14][15]. For this reason, the syndrome has also been referred to as "stress-induced" cardiomyopathy.…”

Frequently Recurrent Takotsubo Syndrome in COPD

“…“Bronchogenic TTS” has been proposed as a specific form of TTS that occurs during severe acute dyspnea in asthma or COPD, with atypical presentation [10–12]. Recurrent TTS in COPD seems to be exceptionally rare since only a handful of clinical cases have previously been reported in the literature [13, 14]. Here, we present a unique case of frequently recurrent TTS during COPD exacerbation with at least 4 different episodes of TTS.…”