Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2019; 11(3): 120-125
Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.120
Utility of recognizing early electrocardiogram changes in bronchogenic Takotsubo cardiomyopathy: A case report
Maria Khan, Husam Watti, Khagendra Dahal, Paari Dominic
Maria Khan, Department of Internal Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
Husam Watti, Khagendra Dahal, Paari Dominic, Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
Author contributions: Khan M designed the report, collected the patient’s clinical data, analyzed the data and wrote the paper; Watti H reviewed and revised the paper, collected and analyzed images and imaging related information; Dahal K revised and reviewed the paper, and analyzed images; Dominic P reviewed and revised the paper.
Informed consent statement: Consent was obtained the patient’s next of kin by the primary author for publication of this report and any accompanying images.
Conflict-of-interest statement: All of the authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) were implemented in the production of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maria Khan, MD, Doctor, Department of Internal Medicine, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71130, United States. mkhan9@lsuhsc.edu
Telephone: +1-816-8638730
Received: January 11, 2019
Peer-review started: January 11, 2019
First decision: January 26, 2019
Revised: March 1, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: March 26, 2019
Processing time: 88 Days and 4 Hours
Abstract
BACKGROUND

Takotsubo cardiomyopathy (TCM) is a transient reversible systolic dysfunction, estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome (ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram (EKG) findings; many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.

CASE SUMMARY

This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology; this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6, and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM. Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.

CONCLUSION

This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.

Keywords: Takotsubo cardiomyopathy; Apical ballooning; Case report; Early electrocardiogram changes; Chronic obstructive pulmonary disease exacerbation; Broken heart syndrome

Core tip: This case report presents a unique opportunity to exemplify specific electrocardiogram (EKG) changes noted in patients with Takotsubo cardiomyopathy (TCM). Low QRS voltage and attenuation of the amplitude of the QRS complex have been noted in the EKGs of TCM patients. This case report presents a patient who had an EKG performed 12 wk prior to developing TCM and thus provides a recent EKG to compare the EKG changes noted during TCM.