Stress Cardiomyopathy Caused by Diving: Case Report and Review of the Literature

Abstract Background Stress cardiomyopathy is characterized by transient myocardial dysfunction that mimics a myocardial infarction in the absence of obstructive coronary artery disease. The onset is frequently triggered by an acute illness or intense physical or emotional stress. Case Report We desc...

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Bibliographic Details
Published in:The Journal of emergency medicine 2016-02, Vol.50 (2), p.277-280
Main Authors: Baber, Aurangzeb, MD, Nair, Sanjeev U., MD, Duggal, Sumit, MD, Bhatti, Salman, MD, Sundlof, Deborah W., DO
Format: Article
Language:English
Subjects:
acute coronary syndrome
Acute Disease
Anxiety - etiology
cardiomyopathy
diving
Diving - adverse effects
Diving - psychology
Emergency
Female
Humans
Middle Aged
pulmonary edema
Pulmonary Edema - diagnostic imaging
Pulmonary Edema - etiology
Radiography
stress
stress-induced cardiomyopathy
Takotsubo Cardiomyopathy - etiology
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Summary:Abstract Background Stress cardiomyopathy is characterized by transient myocardial dysfunction that mimics a myocardial infarction in the absence of obstructive coronary artery disease. The onset is frequently triggered by an acute illness or intense physical or emotional stress. Case Report We describe the case of a 47-year-old woman who was brought to the emergency department with acute onset shortness of breath while scuba diving. She was found to have acute pulmonary edema radiographically. Her troponins were noted to be positive. Initial echocardiogram showed basal hypokinesis with hyperkinesis of apex. She was treated with noninvasive ventilation and intravenous diuretic therapy and her symptoms significantly improved. She subsequently underwent cardiac catheterization which revealed nonobstructive coronary artery disease. An exercise stress echocardiogram was performed 2 days later that revealed resolution of the wall motion abnormality and no ischemia at high levels of exercise. A diagnosis of reverse stress (Takotsubo) cardiomyopathy was made based on Mayo Clinic Diagnostic criteria. ​Why Should an Emergency Physician Be Aware of This? This case brings to light the risk of stress cardiomyopathy in divers. The diagnosis should be considered in patients presenting with acute pulmonary edema during diving.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2015.09.045