Severe Hyponatremia-Induced Stress Cardiomyopathy: A Case Report and Review of Literature

Abstract

Takotsubo or stress cardiomyopathy is a non ischemic disease affecting the myocardium, which presents with typical features of myocardial ischemia. Although the presentation with acute central chest pain and shortness of breath mimics acute myocardial ischemia, there is an absence of actual disruption of cardiac blood supply via the coronaries due to acute plaque rupture or vascular spasm. The underlying pathophysiology of this clinical entity remains largely unclear, but a definite association with physical or emotional stress has been well established, hence the term “stress cardiomyopathy.” The list of potential triggers continues to grow as the disorder is increasingly detected by clinicians and cardiologists, with better clinical insight and improved availability of cardiac investigations. We report a patient with Takotsubo cardiomyopathy associated with severe hyponatremia.

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion

“…In this regard, continuous pain, anxiety, and inflammation suffered by the patient were also potent stimulus for the release of vasopressin by the neurohypophysis, where excess vasopressin became a clinical problem when there was a retention of water producing hypo-osmolality, which contributed to SIADH. The severity and velocity with which hypo-osmolality secondary to hyponatremia develops are likely to be a deciding factor for the occurrence of SCM, as chronic persistent hyponatremia is a less likely trigger 18 . Cardiac magnetic imaging suggesting myocardial edema has been reported in SCM, which could mean that some cell swelling attributed to hyponatremia could also induce myocardial damage and interfere with inotropism by modulation of cardiomyocyte Na+/Ca2+ exchange 19,20 .…”

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

“…But the role of ultrasound imaging does not end here. Through its definition, TS is a reversible systolic dysfunction, thus extending the role of echocardiography from diagnosis to follow-up [ 76 , 77 ] [Fig. 2 ].…”