Syncope in a hypertrophic heart at a wedding party: can happiness break a thick heart? Takotsubo cardiomyopathy complicated with left ventricular outflow tract obstruction in a hypertrophic heart

Abstract

A 70-year-old woman with known history of hypertension presented because of a syncopal episode during dinner at a wedding party, followed by chest pain. On physical examination a systolic murmur was noted, and her electrocardiogram showed ST segment elevation in anterior leads. She had elevated troponin levels while echocardiography showed a hypertrophic interventricular septum with dyskinetic apex and left ventricular outflow (LVOT) obstruction. Emergency coronary angiography excluded obstructive coronary artery disease and confirmed the presence of LVOT obstruction with a gradient of 90 mm Hg. A left ventriculography showed hypercontractility of the basal and mid segments with apical wall dyskinesia indicating Takotsubo cardiomyopathy. Patient was discharged after 6 days of hospitalization with normalization of left ventricular function and regression of the LVOT obstruction. This is an interesting case of Takotsubo cardiomyopathy complicated with severe LVOT obstruction in a patient with hypertensive heart disease and a sigmoid septum hypertrophy.

Liraglutide Protects Cardiomyocytes against Isoprenaline-Induced Apoptosis in Experimental Takotsubo Syndrome

“…The main difference between TTS and myocardial infarction, in addition to the absence of coronary occlusion, is the possibility of recovery from ventricular dysfunction and ECG changes [ 4 ]. The increased concentration of blood catecholamines in TTS can cause coronary microvascular dysfunction and spasms of epicardial coronary vessels [ 25 , 26 , 27 , 28 , 29 ]. Catecholamines can increase cardiac contraction via β1 and β2 myocardial receptors in physiological conditions [ 4 ].…”

Intra-Aortic Balloon Pump Exacerbates Left Ventricular Outflow Tract Obstruction in a Patient With Takotsubo and Hypertrophic Cardiomyopathy

“… 1 , 2 The development of superimposed takotsubo cardiomyopathy in patients with underlying HCM is unusual but has been previously reported. 3 , 4 This combination can lead to hemodynamic compromise and shock, mainly through increasing LVOT obstruction, but alternative mechanisms, such as a reduction in systemic vascular resistance, have also been postulated. 5 , 6 , 7 Sherrid et al .…”

Acute Left Ventricular Ballooning: Tools to Differentiate Hypertrophic Cardiomyopathy with Outflow Obstruction from Neurohumoral Takotsubo Syndrome

“…Our literature search yielded case series [ 7 , 8 , 9 , 12 , 13 , 14 ], case reports [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], one prospective cohort study [ 39 ], and one systematic review [ 40 ] that described cases of obstructive HCM with LV ballooning overlapping with neurohumoral Takotsubo syndrome (TTS). We propose key features to differentiate these diagnoses, as shown in Fig.…”