ABSTRACT
OBJECTIVE: To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications. METHODS: A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic. RESULTS: The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia. CONCLUSIONS: Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.
Subject(s)
Heart Atria/abnormalities , Heart Defects, Congenital/diagnosis , Aged, 80 and over , Blood Flow Velocity , Diagnosis, Differential , Echocardiography, Doppler, Color , Female , Heart Atria/diagnostic imaging , Heart Defects, Congenital/complications , Heart Defects, Congenital/physiopathology , Humans , Male , Stroke/diagnosis , Stroke/etiologyABSTRACT
In this article, we describe three patients with heart failure whose 2D echocardiograms showed left ventricular non-compaction cardiomyopathy characterized by prominent trabeculation with deep intertrabecular spaces in the myocardium.
Subject(s)
Cardiomyopathies/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Cardiomyopathies/physiopathology , Diagnosis, Differential , Echocardiography , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/physiopathologyABSTRACT
The authors utilized rapid right atrial pacing and handgrip exercise to provoke myocardial ischemia in 20 participants (age >65 years) who, for reasons of disability, were not candidates for exercise and pharmacologic stress testing. Echocardiographic left ventricular ejection fraction and left ventricular wall motions were obtained during pacing at baseline and at maximal pacing rates and were compared with coronary angiography. Using the failure of left ventricular ejection fraction to increase with pacing as an indicator of myocardial ischemia, the test yielded a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 71%. When a pacing-induced decrease of wall-motion index was taken as an ischemia indicator, the sensitivity was 63%, specificity 100%, positive predictive value 100%, and negative predictive value 80%. Rapid atrial pacing echocardiography is a safe test. It may be considered in a select group of elderly patients as an alternative to exercise or pharmacologic tests before resorting to coronary angiography.
