Takotsubo Cardiomyopathy as a Delayed Complication with a Herbicide Containing Glufosinate Ammonium in a Suicide Attempt: A Case Report

Abstract

Background. Glufosinate ammonium has a famous delayed complication as respiratory failure, however, delayed cardiogenic complication is not well known. Objectives. The aim of this study is to report a takotsubo cardiomyopathy as a delayed complication of glufosinate ammonium for suicide attempt. Case Report. A 75-year-old woman ingested about 90 mL of Basta, herbicide for suicide attempt at arousal during sleep. She came to our hospital at twelve hours after ingesting. She was admitted to our hospital for fear of delayed respiratory failure. Actually, she felt down to respiratory failure, needing a ventilator with intubation at 20 hours after ingesting. Procedure around respiratory management had smoothly done with no delay. Her vital status had been stable, however, she felt down to circulatory failure and diagnosed as Takotsubo cardiomyopathy at about 41 hours after ingestion. There was no trigger activities or events to evoke mental and physical stresses. Conclusion. We could successfully manage takotsubo cardiomyopathy resulted in circulatory failure in a patient with glufosinate poisoning for suicide attempt. Takotsubo cardiomyopathy should be taken into consideration if circulatory failure is observed for unexplained reasons.

Clinical characteristics of stress cardiomyopathy in patients with acute poisoning

“…A majority of this class of herbicides contain an anionic surfactant that increases blood permeability, resulting in decreasing circulatory blood volume, cardiac function, and resistance of systemic peripheral vessels 20 , 21 . One case report showed that Takotsubo cardiomyopathy was a delayed complication with a herbicide containing glufosinate ammonium in a suicide attempt 7 . Surfactant volume might be an important factor in patients with surfactant-containing herbicide poisoning 21 – 23 .…”

“…A cardiogenic event generally occurs as a result of the direct effects of poisons on contractility or inotropy of the heart. However, some reports have shown that takotsubo cardiomyopathy, also known as transient left ventricular ballooning syndrome or stress cardiomyopathy, could be one of the causes of cardiac complication in patients with acute poisoning 4 – 7 . Takotsubo cardiomyopathy is characterized by transient, reversible ventricular dysfunction with normal coronary arteries 8 .…”

“…This situation might be an important factor that causes takotsubo cardiomyopathy. Although there are some published case reports of stress-induced cardiomyopathy in patients with acute poisoning 5 – 7 , 10 , the incidence or clinical course of takotsubo cardiomyopathy in these patients has not been evaluated. Therefore, we retrospectively investigated the clinical features of Takotsubo cardiomyopathy in patients with acute poisoning.…”

Stress (Takotsubo) Cardiomyopathy in Poisoned Patients

“…To our knowledge, no systematic study has evaluated the frequency and mechanisms in this setting. We report TTC described in the literature after poisoning with non direct sympathomimetic substances in table 2 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Takotsubo cardiomyopathy induced by acute inhalation of hypochlorite drain gel exhalations

“…Tominaga et al previously reported a Takotsubo cardiomyopathy case complicating the contact with a herbicide containing glufosinate ammonium in a suicide attempt [8]. In other cases, apical ballooning was caused by phenylephrine inhaled for relieving nasal congestion [9].…”