Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6517-6523
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6517
Takotsubo cardiomyopathy associated with bronchoscopic operation: A case report
Bi-Feng Wu, Jia-Ran Shi, Liang-Rong Zheng
Bi-Feng Wu, Jia-Ran Shi, Liang-Rong Zheng, Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Wu BF and Shi JR collected the patient’s clinical data; Wu BF drafted the manuscript; Zheng LR provided supervision and critical revision of the manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Liang-Rong Zheng, MD, PhD, Doctor, Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. 1191066@zju.edu.cn
Received: September 17, 2020
Peer-review started: September 17, 2020
First decision: September 24, 2020
Revised: October 3, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: December 26, 2020
Abstract
BACKGROUND

Takotsubo cardiomyopathy (TTC), a syndrome of acute left ventricular (LV) dysfunction, is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. The symptoms of TTC mimic acute myocardial infarction, without significant coronary stenoses on coronary angiography. Echocardiogram plays a key role in the diagnosis and prognosis of TTC. New indicators from echocardiograms may be helpful in disease evaluation.

CASE SUMMARY

A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough. Bronchoscopic lavage, brushing, and biopsy were performed to evaluate tumor progression. During this procedure, he complained of left chest pain, nausea, and vomiting, with elevated troponin levels. Electrocardiogram showed sinus bradycardia with ST-segment elevation in I, AVL, and V4 to V6 leads. Coronary angiography revealed mild stenosis in the right coronary artery. Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. At the 7-d follow-up, echocardiographic pressure-strain analysis showed a normal LV ejection fraction, but partial recovery of LV myocardial work, which fully recovered 5 mo later.

CONCLUSION

This is a case of TTC caused by bronchoscopic operation. We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.

Keywords: Takotsubo cardiomyopathy, Bronchoscope, Left ventricular myocardial work, Case report, Non-small cell lung cancer

Core Tip: In this paper, we report a case of Takotsubo cardiomyopathy caused by bronchoscopic operation, which is rare in clinical practice. The diagnosis is clear. And some novel indicators from echocardiogram were measured, like left ventricular myocardial work index and left ventricular myocardial work efficiency, to evaluate the recovery of ventricular function accurately.