Takotsubo cardiomyopathy associated with diving

Abstract

Takotsubo cardiomyopathy consists of cardiomyopathy with transient apical ballooning and left ventricular systolic dysfunction in the absence of atheromatous disease of the coronary arteries, accompanied by ECG changes together with elevated cardiac enzymes appearing in a context of emotional or physical stress. A 51-year-old woman was referred to our emergency department for treatment after chest pain associated with acute dyspnoea during diving. On questioning, the patient confirmed that she had twice dived to 35 m without any missed decompression stops and informed us that she had experienced tightening of the chest followed by sudden dyspnoea during her second ascent in a setting of marked emotional stress since the previous evening. Her ECG showed inverted T-waves in DI, aVL, V1 and V2, whereas chest radiographs revealed bilateral infiltration of the lower half of the lung fields and a globular heart. Laboratory tests revealed: troponin Ic 7.49 μg/l, myoglobin 206 μg/l, creatine phosphokinase 341 IU/l and N-terminal prohormone brain natriuretic peptide 7919 ng/l. Echocardiography performed in the emergency department showed left ventricular hypokinesia in the medioapical segment with an appearance of apical ballooning, hyperkinesia of the basal portion and a left ventricular ejection fraction of 35%. Coronary angiography revealed healthy coronary arteries. In conclusion, diagnosis of takotsubo cardiomyopathy is based on the guidelines issued at a consensus conference of the Idiopathic Cardiomyopathy Research Committee. This case shows the possibility of this syndrome occurring while diving.

Stress Cardiomyopathy Caused by Diving: Case Report and Review of the Literature

“…We performed a literature search through PubMed and Medline of all available English language articles pertaining to stress cardiomyopathy and diving. We came across only 2 articles addressing this issue (4,9). Chenaitia et al reported a case of Takotsubo cardiomyopathy in a 51-year-old woman after diving to a depth of 35 meters.…”

“…Less commonly, there may be hypokinesis of the mid-ventricle or hypokinesis of the base with sparing of the mid-ventricle and apex, also referred to as inverse or reverse Takotsubo (3). There have been few reported cases of Takotsubo cardiomyopathy associated with diving (4,5). We describe a case of stress cardiomyopathy caused by diving and review the available literature on this subject.…”

Causes of ischemic electrocardiographic changes in near drowning: A literature review

“…Two cases were excluded, the first was a 79-year-old woman who developed TC after a swimming accident where the patient was dragged by the stream but immediately rescued by lifeguards without drowning [5], and the second case was a 51-year-old woman who developed TC from a diving accident after she had dived twice to 35 m without any decompression stops [6]. The remaining 8 cases of near drowning [4,[7][8][9][10][11][12][13] had a mean age of 53 years, and 75% were males.…”

Immersion Pulmonary Edema and Comorbidities

“…(These latter diagnoses were not included in Table 1.) Of the 50 IPE cases found to have evidence of cardiac dysfunction, valvular disease was found in 6 cases (6,29,34) and LV dysfunction was found in 26 cases (5,11,14,20,27,35,60) ( Table 2). The mean age of those with risk factors for coronary artery disease (hypertension, hypercholesterolemia, or smoking history) was 53.0 T 6.8 yr versus 45.7 T 12.0 yr in those without risk factors (P = 0.0001).…”