Takotsubo cardiomyopathy caused by COPD exacerbation




Aftabizadeh, Som


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Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 57-year-old female with severe COPD who presented with syncope and was found to have stress-induced cardiomyopathy. TCM associated with COPD is a rare and raises the possibility of a common underlying mechanism. A 57-year-old female presented to the ER with respiratory failure after she was found unresponsive. Her past medical history included severe COPD, hypertension, and active tobacco abuse. Her EKG on arrival showed sinus tachycardia and PR segment depression as well as repolarization abnormalities in inferior leads. Labs were significant for elevated BNP and troponemia. An TTE on admission revealed severely reduced LV systolic function and severe diffuse LV hypokinesis. A toxicology screen was notably negative for cocaine. She was treated for COPD exacerbation and NSTEMI and improved over the course of the next three days. Coronary angiography revealed non-obstructive coronary artery disease. Repeat TTE four days after admission showed her LV dysfunction had resolved. TCM is characterized by reversible LV dysfunction that is unrelated to obstructive CAD. While rare, literature of review shows several cases of TCM have been associated with both COPD and asthma exacerbation. With catecholamines playing a key role to the pathogenesis of the disease, beta-adrenergic stimulation may be a potential trigger. Some sources speculate that the disproportionate predominance of sympathetic over parasympathetic activity during a COPD exacerbation could be a trigger for TCM.