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.
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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)