A Case of Takotsubo Cardiomyopathy

Background: Takotsubo cardiomyopathy also called apical ballooning syndrome, or stress-induced cardiomyopathy, occurs typically in older women after sudden intense emotional or physical stress. The ventricle shows global ventricular dilation with basal contraction, forming the shape of the narrow-necked jar (takotsubo) used in Japan to trap octopi. Presentations include pulmonary edema, hypotension, and chest pain with Electrocardiogram changes mimicking an acute infarction. This acute cardiomyopathy may result from intense sympathetic activation with the heterogeneity of myocardial autonomic innervation, diffuse microvascular spasm, and/or direct catecholamine toxicity. Coronary angiography may be required to rule out acute coronary occlusion. Treatment includes supportive, conservative therapy and standard heart failure regimen for Left Ventricular Dysfunction. Prognosis is generally good. Case History: A 43 year old female patient presented with thyroid swelling since 5 years. She was taking treatment for hypothyroidism.There was no past history of diabetes mellitus, hypertension, coronary artery disease and other comorbidities. She underwent total thyroidectomy for multinodular goiter following which the patient developed sudden onset of retrosternal chestpain associated with palpitations on the first postoperative day. Investigations: Before the surgery her Electrocardiogram was normal and Two-Dimensional Echocardiography showed good left ventricular function with an ejection fraction of 60%. After the surgery, the Electrocardiogram of the patient showed ST elevations in I, aVL and V3 to V6 leads. Echocardiography revealed hypokinetic Left anterior descending artery territory with apical ballooning, moderate to severe Left Ventricular dysfunction with ejection fraction reduced to 34%. Cardiac markers were mildly elevated. Coronary angiogram was normal. Treatment: She was treated for heart failure with diuretics, Angiotensin Converting Enzyme inhibitors, and beta-blockers. ST elevations resolved in 3 days and her left ventricular function improved over a period of 4 weeks.