2019 Research Forum

Presenter: Ahana Sandhu MD R3 Principal Investigator & Faculty Sponsor Tiffany Win MD

Takotsubo Cardiomyopathy in a Patient with Hypovolemic Shock and Methamphetamine Use

Ahana Sandhu MD R3, Kieran Doyle MS IV, Kathleda Tangonan MS IV, Tiffany Win MD, Fowrooz Joolhar MD

INTRODUCTION 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.

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

DISCUSSION We present a case of a 62-year-old femalewith 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 was done when a cardiac murmur auscultated on examination revealed preserved ejection fraction. Over the course of the admission, this patient was weaned off 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. 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. CONCLUSION 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.

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