2019 Research Forum

Ahana Sandhu MD R3, Kieran Doyle MS IV, Kathleda Tangonan MS IV, Tiffany Win MD, Fowrooz Joolhar MD TAKOTSUBO CARDIOMYOPATHY IN PATIENT WITH HYPOVOLEMIC SHOCK & METHAMPHETAMINE USE Department of Medicine, Kern Medical, Bakersfield, CA United States

Conclusions

Introduction

Discussion

Takotsubo cardiomyopathy, or broken heart syndrome, is thought to be due to massive released of catecholamines in response to extreme emotional insults. It has been reported throughout the literature in medicine. However large amounts of sympathetic activation and catecholamine release is not limited to realms of emotional triggers but can also be seen during times of severe hypovolemic shock, as well as in the presence of amphetamine ingestion, leading to similar cardiac findings on transthoracic echocardiogram as those seen in Takotsubo.

Takotsubo cardiomyopathy it seems is not a phenomenon limited to matters of a broken heart but can be seen in the patient population who abuse illicit drugs, especially those that release catecholamines and which prevent their reuptake such as amphetamines as well as in extreme cases of hypovolemic shock. To this point, it becomes of the utmost important to keep this disease process as part of the differential diagnosis when approaching these patients. 1) Amphetamine-induced cardiomyopathy: Patterns and predictors of recovery. A. Voskoboinik ∗ , J. Ihle, D. Kaye Alfred Hospital, Australia 2) A Case Report of Reversible Takotsubo Cardiomyopathy after Amphetamine/Dextroamphetamine Ingestion in a 15-Year-Old Adolescent Girl.The Journal of pediatrics, ISSN: 1097-6833, Vol: 182, Page: 385- 388.e3. Publication Year: 2017 3) Reverse or inverted left ventricular apical ballooning syndrome (reverse Takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use. Movahed MR1, Mostafizi K. Echocardiography. 2008 Apr;25(4):429-32. doi: 10.1111/j.1540-8175.2007.00604.x. Epub 2008 Jan 3. 4) A case of reverse takotsubo cardiomyopathy caused by an eating disorder. TravisTagamiDOAmyMertensDODanielRothschildMDP erthaChowdhuryMD. William Beaumont Health System, Royal Oak, MI, USA. Journal of Cardiology Cases Volume 15, Issue 3, March 2017, Pages 77-79 5) Amphetamine Use Induced Takotsubo Cardiomyopathy Treated With Venoarterial Extracorporeal Membrane Oxygenation. Holst T1, MakariousLaham M1, Heckmann J2, Roosta-Azad M1, Bigdeli H1, Zandi A1 , Koch A2 and Kamler M*1,2.Heart Center Essen Huttrop, University Hospital Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Germany Received: January 09, 2018; Published: January 18, 2018 6). Health.Harvard.edu-ImagesTakoTsubo 7) Takotsubo Cardiomyopathy A New Form of Acute, Reversible Heart Failure Yoshihiro J. Akashi, MD, PhD; David S. Goldstein, MD, PhD; Giuseppe Barbaro, MD; Takashi Ueyama, MD, PhD

Electrocardiogram done did not show any ischemic changes, however, a repeat transthoracic echocardiogram done showed reduced ejection fraction with typical finding of Takotsubo cardiomyopathy (apical ballooning present on imaging and akinetic chamber walls). This patient underwent cardiac catheterization which showed no significant atherosclerosis. This patient required continued care in the intensive care unit. She was discharged home on an optimized medication regimen targeting her reduced ejection fraction congestive heart failure and repeat transthoracic echocardiogram showed improvement in the patient’s ejection fraction.

References

Purpose

To discuss the importance of diagnosis, further evaluation and management of Takotsubo Cardiomyopathy and the multiple factors that can contribute to it.

Health.Harvard.edu

Discussion

We present a case of a 62-year-old female with a history of Chronic obstructive pulmonary disease, amphetamine abuse and an extensive psychiatric history who presented to the emergency department with generalized weakness, with hypotension and an acute kidney injury. Initial urine toxicology was positive for methamphetamine. This patient required fluid resuscitation and vasopressor support to maintain her hemodynamic status and was admitted under the care of the intensive care unit. Initial transthoracic echocardiogram done because of a cardiac murmur auscultated on examination revealed preserved ejection fraction. Over the course of the admission this patient was weaned off of vasopressors and transferred to the medical surgical floor. However, she had another deterioration in her health and an episode of non-sustained ventricular tachycardia and elevated troponin on labs.

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