Takotsubo cardiomyopathy mid ventricle variant and cardiac arrest: chicken or the egg?

Takotsubo cardiomyopathy (TTC) is uncommon emergency condition usually precipitated by emotional or physical stress and is characterized by near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular territory. Variants of TTC include classic ap...

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Bibliographic Details
Published in:The American journal of emergency medicine 2013-05, Vol.31 (5), p.890.e1-890.e2
Main Authors: Singh, Kuljit, MD, Parsaik, Ajay K., MD, Zeitz, Christopher J., MD, PhD, FRACP
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiac arrest
Cardiac arrhythmia
Cardiopulmonary resuscitation
CPR
Emergency
Emergency medical care
Fatal Outcome
Female
Heart attacks
Humans
Medical imaging
Middle Aged
Out-of-Hospital Cardiac Arrest - etiology
Risk factors
Takotsubo Cardiomyopathy - complications
Takotsubo Cardiomyopathy - diagnosis
Veins & arteries
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Summary:Takotsubo cardiomyopathy (TTC) is uncommon emergency condition usually precipitated by emotional or physical stress and is characterized by near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular territory. Variants of TTC include classic apical ballooning syndrome and less commonly, mid, basal, and biventricular variants. Cardiac arrest is an uncommon complication of TTC. In the convalescence phase of TTC, prolonged QTc interval may cause cardiac arrest, but the reason for cardiac arrest in the acute phase when QTc interval is normal is unclear. We report 3 cases of mid ventricular TTC, with out-of-hospital cardiac arrest as the presenting feature. All 3 patients had normal QTc interval and were found to have normal coronary arteries on cardiac catheterization at presentation. Mid ventricular TTC was confirmed on contrast left ventriculography and echocardiography. Cardiac arrest myocarditis was ruled out by myocardial biopsy in 2 deceased patients and by cardiac magnetic resonance imaging in the one who survived.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2012.12.037