Takotsubo Cardiomyopathy in the Emergency Department: A FOCUS Heart Breaker

Abstract

Takotsubo cardiomyopathy (TCM) is an important condition for the emergency physician to consider in patients with cardiovascular symptoms. A 70-year-old woman presented with chest pain and nausea following emotional trauma. She had an elevated troponin and a normal electrocardiogram with no history of previous cardiac disease. Point-of-care focused cardiac ultrasound (FOCUS) showed reduced left ventricular systolic function with mid to apical hypokinesis. Cardiac catheterization revealed clean coronary arteries and confirmed the suspected diagnosis of TCM. Few reports emphasize the importance of FOCUS in the diagnosis and management of TCM in the emergency department. We detail FOCUS findings that assisted with diagnosis of TCM and describe how this quick, noninvasive imaging modality can be used to assess and manage emergent conditions.

Early Identification of Takotsubo syndrome in the emergency department using point‐of‐care echocardiography: A case series

“…9 However, bedside echocardiography has previously been reported to have a role in suggesting TS in the ED. [10][11][12] Our three-case series further confirms that the circumferential apical ballooning of TS can be identified in the ED with POCUS performed by emergency physicians. Further, we show how early recognition may influence the patient's clinical course.…”

“…As stated, current algorithms do not explicitly include emergency POCUS as part of the diagnostic pathway 9 . However, bedside echocardiography has previously been reported to have a role in suggesting TS in the ED 10‐12 . Our three‐case series further confirms that the circumferential apical ballooning of TS can be identified in the ED with POCUS performed by emergency physicians.…”

Will Mary Jane Leave You Heartbroken? Marijuana Use and Risk of Takotsubo Cardiomyopathy

“…Takotsubo cardiomyopathy has often been associated with hypercatecholaminergic states. A recent study showed that patients with TTC had catecholamine levels that were 2 to 3 times greater than patients with classic MI's, resulting in microvascular spasm and myocardial stunning likely secondary to beta-receptor mediated sympathetic stimuli [3,12-14]. Regarding the role of marijuana in TTC, it has been theorized that the endocannabinoid system may also cause physiologic stress as illustrated above, leading to cardiomyopathy.…”

A woman with chest pain

“…Although TCM is a diagnosis of exclusion, POCUS has been described as a modality that may help identify these patients and affect downstream decision‐making. 3 , 4 There is no clear suggested management for patients with TCM, and care is supportive. Most patients recover over the course of weeks to months.…”