Robles P, Monedero I, Rubio A, Botas J. Reverse or inverted apical ballooning in a case of refeeding syndrome. World J Cardiol 2015; 7(6): 361-366 [PMID: 26131342 DOI: 10.4330/wjc.v7.i6.361]
Corresponding Author of This Article
Pablo Robles, MD, Departament of Cardiology, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922 Alcorcón, Madrid, Spain. probles@fhalcorcon.es
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Cardiol. Jun 26, 2015; 7(6): 361-366 Published online Jun 26, 2015. doi: 10.4330/wjc.v7.i6.361
Reverse or inverted apical ballooning in a case of refeeding syndrome
Pablo Robles, Isabel Monedero, Amador Rubio, Javier Botas
Pablo Robles, Isabel Monedero, Amador Rubio, Javier Botas, Departament of Cardiology, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Madrid, Spain
Author contributions: Robles P and Monedero I reviewed the literature and wrote the manuscript; Rubio A made the electrophysiologic analysis and contributed to the writing of the manuscript; Botas J was involved in revising the manuscript critically for important intellectual content.
Supported by Hospital Universitario Fundación Alcorcón, Madrid (Spain).
Ethics approval: This case report was reviewed and approved by the Hospital Universitario Fundación Alcorcón Institutional Review Board.
Informed consent: Request for waiver of informed consent in attached file.
Conflict-of-interest: There is no conflict of interest with any financial organization regarding the material discussed in the 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/
Correspondence to: Pablo Robles, MD, Departament of Cardiology, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922 Alcorcón, Madrid, Spain. probles@fhalcorcon.es
Telephone: +34-916-817330 Fax: +34-916-219928
Received: October 26, 2014 Peer-review started: October 28, 2014 First decision: November 14, 2014 Revised: December 2, 2014 Accepted: April 8, 2015 Article in press: April 9, 2015 Published online: June 26, 2015 Processing time: 241 Days and 15.5 Hours
Abstract
Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities, in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments, but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic, sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman, with chronic malnutrition, initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram (ECG), elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge, this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.
Core tip: Inverted Takotsubo is a stress-induced cardiomyopathy type that could be encountered in patients suffering from varied physical or emotional triggers. In this report we describe the first case following a refeeding syndrome. There are reported cases of classical apical Takotsubo associated with nutrition disorders, but none of them presenting with the inverted variant.
