Octopus Unveiled: Sudden Onset Takotsubo Cardiomyopathy as a MI Mimic in Women

Abstract

Case: A 71 year old female with medical history of diabetes mellitus and hypertension presented to the emergency department with pneumonia symptoms and headache radiating to the right jaw. She presented to the ED a few days prior due to a fall, in which all workup was negative. In the ED, she experienced a hypoxic episode, tachycardia, and dyspnea which necessitated placement on supplemental oxygen and admission to the hospital for further workup. The next day she developed acute hypoxic respiratory failure requiring intubation and later found to have STEMI with total occlusion of the LAD coronary artery. Percutaneous coronary intervention was complicated by LAD perforation, resulting in takotsubo cardiomyopathy (TCM) and cardiogenic shock from tamponade. Echocardiography showed reduced left ventricular ejection fraction from 69% one hour before onset to 25% with hypokinesis in the apical (LAD) distribution. Metoprolol succinate, placement of pericardial drain, and intra-aortic balloon pump (IABP) resolved her shock. Conclusions: This case of takotsubo cardiomyopathy is significant because of the atypical cause, her successful treatment with IABP, and the rapid management of her condition. Her unusual case was caused by an interventional complication rather than an emotional stressor which highlights the importance of monitoring for TCM after PCI perforation. Her TCM was resolved within 11 days of onset through utilization of an IABP and pericardial drain. While IABPs are frequently used in TCM management, recent studies discovered that IABP had no significant improvement in mortality or morbidity for TCM patients compared to no intervention. However, this patient’s successful treatment with an IABP indicates that this may still be a useful intervention in patients with TCM complicated by cardiogenic shock. Postmenopausal women are at a high risk for developing TCM as a complication of other high-stress disease states. This patient, a postmenopausal, diabetic woman experiencing emotional stress and a post-infectious state, presented with the typical comorbidities for TCM. Her timely diagnosis allowed for a favorable patient outcome despite her high mortality risk. This case highlights the importance of considering TCM as the underlying pathology in high-risk populations.