Takotsubo cardiomyopathy secondary to respiratory failure with intubation

SESSION TITLE: Cardiovascular Disease Case Report Posters 21 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Takotsubo cardiomyopathy (TCM) is a cardiac condition that mimics acute coronary syndrome (ACS) and is characterized by transient left ventricular dysfunction and apical ballooning in the absence of obstructive coronary artery disease. Recent studies have shown that TCM can be triggered by acute respiratory distress (1). Here, we report a case of TCM triggered by intubation due to acute respiratory failure. CASE PRESENTATION: A 73-year-old man with a medical history of COPD, hypertension, hyperlipidemia, DM2, and interstitial lung disease on the lung transplantation list presented with dyspnea. He was speaking in short sentences but denied any cough, fever, or hemoptysis. Upon admission to the critical care unit, he was diagnosed with acute on chronic hypoxemia and hypercapnic respiratory failure due to COPD exacerbation. Significant findings on admission included a SpO2 of 84%, a heart rate of 130, and a respiratory rate of 34. He received albuterol and ipratropium nebulizers, IV steroids, and bilevel ventilation. His condition worsened, with increasing hypoxemia, tachypnea, and tachycardia, leading to intubation. Shortly after intubation, an ECG revealed ST elevations in anteroseptal, lateral, and inferior leads, while a Transthoracic Echo (TTE) showed severely reduced EF of 15% and left ventricular apical akinesis with basal excursion, consistent with TCM. He was started on aspirin and ticagrelor and received norepinephrine due to progressive hypotension. An emergent left and right heart catheterization showed nonobstructive coronary artery disease and elevated left-sided pressures (mPAP 41, PCWP 19, CI 2.6), confirming the diagnosis of TCM. DISCUSSION: TCM is a rare but potentially life-threatening condition (1). Diagnosis can be challenging since TCM often presents similarly to acute ACS. Various triggers, such as emotional and physical stress, have been associated with the development of TCM. In this case, acute respiratory failure and subsequent intubation were likely the triggering factors. Tracheal manipulation as a cause of TCM was reported in three other female patients (2, 3). A comprehensive review of 3,117 studies identified 108 patients with TCM caused by respiratory distress, including COPD, asthma, pneumonia, pulmonary embolism, and lung cancer (1). Dyspnea was present in 70.48% of cases. The exact mechanism underlying the association between respiratory diseases and TCM remains unclear, but it has been hypothesized that stress hormones, such as catecholamines, released during respiratory distress, may trigger TCM (2). CONCLUSIONS: This case report highlights the association between intubation and TCM. Clinicians should be aware of this potential trigger and consider TCM in the differential diagnosis of patients presenting with ACS-like symptoms following intubation. Prompt diagnosis and management are crucial in preventing complications and improving outcomes. REFERENCE #1: Li P, Wang Y, Liang J, Zuo X, Li Q, Sherif AA, Zhang J, Xu Y, Huang Z, Dong M, Teng C. Takotsubo syndrome and respiratory diseases: a systematic review. Eur Heart J Open. 2022 Mar;2(2):oeac009. REFERENCE #2: Taniguchi K, Takashima S, Iida R, Ota K, Nitta M, Sakane K, Fujisaka T, Ishizaka N, Umegaki O, Uchiyama K, Takasu A. Takotsubo cardiomyopathy caused by acute respiratory stress from extubation: a case report. Medicine. 2017 Dec;96(48). REFERENCE #3: Jakobson T, Svitškar N, Tamme K, Starkopf J, Karjagin J. Two cases of takotsubo syndrome related to tracheal intubation/extubation. Medicina. 2012 Feb;48(2):10. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zinobia Khan No relevant relationships by Mirjana Petrovic Elbaz No relevant relationships by Tamara Simpson