Takotsubo syndrome with pulmonary embolism: a case report and literature review

Abstract

BackgroundTakotsubo syndrome (TTS) is an acute cardiac condition with reversible heart failure which is often triggered by psychological and physical stressful events. Although pulmonary embolism (PE) was reported as a trigger for TTS, the concurrence of TTS and PE has been rarely reported, let alone that triggered by PE. Here we describe a case of a postmenopausal female presenting with symptoms similar to myocardial ischemia, which may be caused by PE, and review the available literature that may help clinicians with their practice to similar situations since no published guidelines are available.Case presentationAn 86-year-old female was referred to the emergency department for unrelieved chest tightness, shortness of breath and back pain. Cardiac biomarkers were mildly elevated and electrocardiogram displayed pathologic Q-waves, ST-segment elevation and inverted T-waves. Unexpectedly, coronary angiography was in absence of obstructed coronary atherosclerosis or acute plaque rupture. Chest computed tomography illustrated multiple pulmonary emboli in bilateral pulmonary arteries. She had suffered from long-term right lower extremity pain and experienced a long railway journey with less activity. Both echocardiogram and cardiac magnetic resonance demonstrated regional hypokinesia of left ventricle. She received anticoagulant and diuretic therapies, three-month follow up after discharge revealed uneventful recovery without any pulmonary emboli or regional motion abnormalities, thus she was retrospectively diagnosed with TTS caused by PE.ConclusionTTS and PE are scarcely concurrent and PE can exert as a potential trigger for TTS. TTS is easily misdiagnosed, actively seeking possible risk factors of TTS is in favor of early diagnosis and timely intervention. TTS with PE is reversible, timely and effective treatments ensure the best possible outcome.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0953-7) contains supplementary material, which is available to authorized users.

Późna postać zespołu takotsubo w przebiegu zatorowości płucnej

“…The presented case fulfils the InterTAK diagnostic criteria for TTS (Table 3) [3]. Pulmonary embolism is a rarely described in literature cause of TTS [4]. In the presented case the symptoms of an acute pulmonary embolism constituted both emotional and physical stressors.…”

Takotsubo Syndrome (TTS) in Onco-Hematologic Patients: Retrospective Analysis and Focus on the Correlation or Not With Anticancer Drugs. Case Reports and Review of the Literature

“…Being over 60 years of age and having a poor performance status have a significant influence on the occurrence of thromboembolism in patients with newly diagnosed diffuse large B-cell lymphoma who have received rituximab plus vincristine, doxorubicin, cyclophosphamide ( 20 ). PE is considered as a potential trigger for secondary TTS ( 21 ), but TTS with PE is rarely reported ( 22 ). In the second case we used rituximab, plus vincristine, liposomal doxorubicin, cyclophosphamide.…”

Happy heart syndrome mimicking acute pulmonary embolism and acute coronary syndrome

“…Because TC shares similar clinical presentations with acute coronary syndrome and acute pulmonary embolism, it is easily misdiagnosed. Although acute pulmonary embolism is reported as a trigger for TC, the concurrence of TC and pulmonary embolism has rarely been reported ( 5 ).…”