Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report

Journal of Medical Case Reports, Dec 2008

Introduction Takotsubo cardiomyopathy has increasingly been reported in the medical literature in recent years. Much is still unknown regarding risk factors and clinical relationships. We contribute this case report to the growing set of literature on the topic. Case presentation We report the case of a 64-year-old woman with esophageal cancer who developed takotsubo cardiomyopathy, a form of reversible heart failure, and we present a review of the literature. Patients present with symptoms similar to an acute coronary syndrome; however, cardiac catheterization reveals patent coronary arteries, and symptoms of heart failure resolve completely within weeks. Conclusion It is important that clinicians consider takotsubo cardiomyopathy in the differential diagnosis of heart failure and gain a basic understanding of the clinical presentation and diagnosis.

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Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report

Journal of Medical Case Reports Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report Tara C Gangadhar 1 2 Elisabeth Von der Lohe 0 1 2 Stephen G Sawada 0 1 2 Paul R Helft 1 2 3 0 Division of Cardiology, Indiana University Medical Center , Indianapolis, IN 46202 , USA 1 Indiana University School of Medicine Indiana University Medical Center , Indianapolis, IN 46202 , USA 2 Department of Medicine, Indiana University Medical Center , Indianapolis, IN 46202 , USA 3 Division of Hematology/Oncology, Indiana University Medical Center , Indianapolis, IN 46202 , USA Introduction: Takotsubo cardiomyopathy has increasingly been reported in the medical literature in recent years. Much is still unknown regarding risk factors and clinical relationships. We contribute this case report to the growing set of literature on the topic. Case presentation: We report the case of a 64-year-old woman with esophageal cancer who developed takotsubo cardiomyopathy, a form of reversible heart failure, and we present a review of the literature. Patients present with symptoms similar to an acute coronary syndrome; however, cardiac catheterization reveals patent coronary arteries, and symptoms of heart failure resolve completely within weeks. Conclusion: It is important that clinicians consider takotsubo cardiomyopathy in the differential diagnosis of heart failure and gain a basic understanding of the clinical presentation and diagnosis. - Introduction Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, has increasingly been reported in the medical literature in recent years. While case series outlining the clinical features of the disease have now been published, much is still unknown regarding risk factors and clinical relationships. We contribute this case report to the growing set of literature on the topic. Case presentation A 64-year-old woman with unresectable squamous cell carcinoma of the mid esophagus was treated with definitive chemoradiotherapy, including 4500 cGy of external beam radiotherapy and two cycles of cisplatin and a continuous venous infusion of 5-fluorouracil. Three months later, she was admitted to the hospital with new onset of choking with both solid and liquid foods. Her past medical history included generalized anxiety disorder and hypercholesterolemia. She had an extensive smoking history, but no known history of cardiac disease. A barium esophagram on admission revealed a tracheo-esophageal fistula for which she underwent a successful endoscopic stent placement with a self-expanding metallic stent. One day after the procedure, the patient developed substernal chest pain. Serial electrocardiograms revealed ST elevation in the anterior and lateral leads. Troponin measurements rose to 12.3 ng/ml; serum creatine kinase MB peaked at 10.6 ng/ml. Echocardiography revealed severely reduced global left ventricular systolic function and normal basal systolic function. Regional wall motion abnormalities were noted in the left anterior descending, left circumflex and right coronary artery distributions. The patient developed clinical signs of left-sided heart failure, including acute hypoxemic respiratory failure, and required intubation and mechanical ventilation. An emergency cardiac catheterization revealed normal, patent coronary arteries. A left ventriculogram revealed apical dilation of the left ventricle with akinesis of the whole ventricle except for the anterior and posterior base (Figure 1). Cardiology consultants felt that the patient's clinical and echocardiographic features met the diagnostic criteria for takotsubo cardiomyopathy [1]. The patient was managed conservatively with diuresis and had a rapid clinical improvement; she was extubated after 2 days. She was found to have marked improvement in regional wall motion and left ventricular systolic function on a repeat echocardiogram 6 days later (Figures 2 and 3). She had no clinical signs of congestive heart failure during follow-up 2.5 weeks later, making an ischemic or radiation induced irreversible cardiomyopathy unlikely. Discussion Takotsubo cardiomyopathy is a rare form of reversible heart failure that has been reported primarily in Japan [24] and, more recently, in Europe and the United States tEFhcieghuoacraeurtd2eiopghraaspeh showing dilatation of the left ventricle in Echocardiograph showing dilatation of the left ventricle in the acute phase. [5,6]. Several cases have been described previously but, to the best of the authors' knowledge, this is the first full case report in a patient with cancer. The name of the syndrome derives from the classic appearance of the left ventricle, with an akinetic apex and hyperkinetic base, which takes the shape of a Japanese octopus fishing pot, or takotsubo. Also known as an apical ballooning syndrome, this cardiomyopathy occurs primarily in women in the seventh and eighth decades of life and is often associated with an acute physiological or emotional stres (...truncated)


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Tara C Gangadhar, Elisabeth Von der Lohe, Stephen G Sawada, Paul R Helft. Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report, Journal of Medical Case Reports, 2008, pp. 379, 2, DOI: 10.1186/1752-1947-2-379