Takotsubo Cardiomyopathy in Elderly Female Trauma Patients

A Case Series

Vishal Patel; Shuli Levy; Iqbal Malik; Michael B. Fertleman; Louis J. Koizia

Disclosures

J Med Case Reports. 2021;15(451) 

In This Article

Background

Originally reported in Japan in 1990, Takotsubo cardiomyopathy is a syndrome characterized by acute left ventricular wall motion abnormalities with a hallmark transient apical ballooning leading to left ventricular systolic dysfunction.[1,2] Commonly mistaken for an acute coronary syndrome (ACS), it can present with transient cardiac ischemia-like symptoms such as chest pain and shortness of breath with electrocardiogram (ECG) changes of ST segment elevation in the absence of significant coronary artery disease. Biochemical markers of cardiac injury (troponin I and T, creatinine kinase, and myoglobin) are usually elevated.[2] The clinical presentation can range from mild symptoms to severe pulmonary edema and cardiogenic shock.[3] With prompt recognition and management, there is usually a good prognosis and low mortality regardless of the severity of the clinical presentation.[4]

The incidence of Takotsubo cardiomyopathy has been reported in around 2% of patients presenting with symptoms suggestive of ACS.[5] It appears to more common in people between the ages of 65 and 70 and in postmenopausal women.[6] Although the pathogenesis is not fully understood, there is evidence to suggest that sympathetic stimulation is integral.[1,7] Increased plasma catecholamine levels in the setting of Takotsubo cardiomyopathy are usually precipitated by an event related to acute physical illness or emotional stress.[7]

For patients presenting following trauma, in urgent need of operative management, the clinical conundrum relates to the concern that these patients are contemporaneously experiencing an ACS. The symptoms, signs, and investigations usually result in delays to operative management and heightened anxiety of the anesthetic risk. Differentiating Takotsubo cardiomyopathy from an ACS may prevent operative delays and avoid inappropriate management.

In this paper we present three cases of Takotsubo cardiomyopathy observed in elderly females admitted to a major trauma center following falls.

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