Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Abstract

Background“Tako-Tsubo cardiomyopathy” (TTC) is a syndrome characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. It most often affects post-menopausal women and TTC tends to run a benign course with very low rates of recurrence, complications or mortality. The condition is also called “stress-induced cardiomyopathy” because acute physical or emotional stress appears to be frequently related to its onset. The pathogenic role of premorbid or comorbid psychiatric illnesses has been discussed controversially. For the first time, we present a case of fourfold recurrent TTC with severe complications in a pre-menopausal woman. Furthermore, a long history of flaring posttraumatic stress symptoms anteceded the first event.Case presentationA 43-year old, pre-menopausal Caucasian woman was hospitalized with symptoms of acute coronary syndrome. Clinical examination revealed hypokinetic wall motion in the apical ventricular region with no signs of coronary artery disease and diagnosis of TTC was established. She experienced recurrence three times within the following ten months, which led to thrombembolism and myocardial scarring among others. The circumstances of chronic distress were striking. 16 years ago she miscarried after having removed a myoma according to her doctor’s suggestion. Since then, she has suffered from symptoms of posttraumatic distress which peaked annually at the day of abortion. Chronic distress became even more pronounced after the premature birth of a daughter some years later. The first event of TTC occurred after a family dispute about parenting.ConclusionThis is the first case report of fourfold TTC in a pre-menopausal woman. From somatic perspectives, the course of the disease with recurrences and complications underlines the fact that TTC is not entirely benign. Furthermore, it is the first case report of long lasting symptoms of traumatic stress anteceding TTC. Close connections between adrenergic signaling and late onset of clinical stress symptoms are well known in the psychopathology of traumatization. Although larger clinical trials are needed to elucidate possible interactions of premorbid psychiatric illnesses and TTC, cardiologists should be vigilant especially in cases of recurrent TTC.

Adult left-ventricular diverticulum and patent ductus arteriosus misdiagnosed as coronary artery disease with infarct aneurysm: a case report

“…No emotional stress, normal cardiac enzyme values and a normal ECG ST-segment were important diagnostic clues of diverticulum in this case. In a characteristic takotsubo ventricle, the base of the left ventricle is hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic [ 10 , 11 ]. However, the echocardiograph of this patient showed normal ventricular function and wall motions, and the apical protrusion was contractile.…”

Mid-ventricular takotsubo cardiomyopathy triggered by major depressive disorder after abortion

“…The use of vasopressors is frequently applied to counterbalance anaesthesia-induced hypotension 1. Hefner et al reported a case of premenopausal women with fourfold TCM related to chronic term post-traumatic distress, triggered by previous miscarriage 2. The common denominator with our case is distress related to pregnancy loss.…”

Ivabradine in Takotsubo cardiomyopathy

“…TTC may be precipitated by eclampsia during pregnancy [21]. Rarely, TTC may have the tendency to be recurrent [22]. TTC is responsible for 1.2-2.2% of total hospital admissions for suspected acute coronary syndrome [23;24].…”