Takotsubo syndrome triggered by emotional and physical stress due to coincidental immobilization resembling the experimental model of the disease - a case report.

The term takotsubo syndrome (TTS) is derived from a comparison of left ventricular (LV) appearance in its apical form to the shape of the pot which is a trap used for octopus catching. In the classical animal model on rats, its occurrence can be triggered by experimental immobilization (IMO). Former observations of capture myopathy, seen in animals after extreme exertion, showed coexistence of rhabdomyolysis related to skeletal muscle injury and myocardial damage. The authors describe a case of a 66-year-old obese female in whom TTS was triggered by an uncommonly stressful event when she had been trapped in the bathtub for several hours. The woman lives alone and has impaired functionality due to degenerative disease of the spine and hips. On this unlucky day, she decided to have a bath after which she was unable to get out of the bathtub despite repeated efforts. She was very frustrated and helpless having to spend all the evening and night in that cul-de-sac-like situation. She was rescued in the morning by neighbors and firemen who transferred her to hospital. On admission she was exhausted and suffering from dyspnea, she negated any chest pain; there were bloody abrasions on her elbows. Due to negative T waves in ECG and elevated troponin I, echocardiography was performed which revealed LV apical ballooning. The high level of creatine phosphokinase (CPK) was suggestive of rhabdomyolysis. Following heart failure therapy, the patient's clinical state, as well as echocardiographic parameters, improved gradually. Normalization of LV function and CPK values was observed after 11 days.

Takotsubo cardiomyopathy triggered by influenza B.

Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account.