Takotsubo syndrome presenting with high-degree atrioventricular block with ventricular asystole

  • Author Footnotes
    1 Hyobae Kown and Jongkwon Seo contributed equally to this paper.
    Hyobae Kown
    Footnotes
    1 Hyobae Kown and Jongkwon Seo contributed equally to this paper.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Author Footnotes
    1 Hyobae Kown and Jongkwon Seo contributed equally to this paper.
    Jongkwon Seo
    Footnotes
    1 Hyobae Kown and Jongkwon Seo contributed equally to this paper.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Byung Gyu Kim
    Correspondence
    Corresponding author at: Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-Gu, Seoul 01757, Republic of Korea.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Gwang Sil Kim
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Moo-Nyun Jin
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Hye Young Lee
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Young Sup Byun
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Byung Ok Kim
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
    Search for articles by this author
  • Author Footnotes
    1 Hyobae Kown and Jongkwon Seo contributed equally to this paper.
Published:September 25, 2021DOI:https://doi.org/10.1016/j.jccase.2021.09.004

      Abstract

      Takotsubo syndrome (TS) is a reversible form of cardiomyopathy characterized by transient systolic dysfunction with regional wall motion abnormalities and absence of coronary artery obstruction, which can be precipitated by severe emotional or physical stress. Its clinical presentation is similar to that of acute coronary syndrome. However, TS presenting with atrioventricular (AV) block with ventricular asystole is rarely reported. In this article, we describe the case of a postmenopausal woman who experienced near cardiac arrest due to high-degree AV block. Although transthoracic echocardiography revealed left ventricular dysfunction with severe global hypokinesia, coronary angiography and cardiac magnetic resonance imaging showed normal coronary arteries without myocardial scarring. The patient's condition improved after permanent pacemaker implantation and medical treatment for heart failure. Echocardiography and pacemaker analysis at two-month follow-up revealed normalization of heart function and cardiac rhythm, and the patient was finally diagnosed with TS.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Medina de Chazal H
        • Del Buono MG
        • Keyser-Marcus L
        • Ma L
        • Moeller FG
        • Berrocal D
        • Abbate A
        Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review.
        J Am Coll Cardiol. 2018; 72: 1955-1971
        • Roshanzamir S
        • Showkathali R.
        Takotsubo cardiomyopathy a short review.
        Curr Cardiol Rev. 2013; 9: 191-196
        • Goico A
        • Chandrasekaran M
        • Herrera CJ.
        Novel developments in stress cardiomyopathy: From pathophysiology to prognosis.
        Int J Cardiol. 2016; 223: 1053-1058
        • Syed FF
        • Asirvatham SJ
        • Francis J.
        Arrhythmia occurrence with takotsubo cardiomyopathy: a literature review.
        Europace. 2011; 13: 780-788
        • Win CM
        • Pathak A
        • Guglin M.
        Not takotsubo: a different form of stress-induced cardiomyopathy–a case series.
        Congest Heart Fail. 2011; 17: 38-41
        • Rathore A
        • Banavalikar B
        • Shenthar J
        • Acharya D
        • Parvez J
        • Setty Srinivasa KH.
        An unusual case of complete atrioventricular block causing takotsubo syndrome.
        Indian Pacing Electrophysiol J. 2018; 18: 123-125
        • Sakul NFN
        • Shrestha S
        • Balabbigari N
        • Talati S.
        Complete heart block: A rare complication of takotsubo syndrome.
        Case Rep Cardiol. 2019; 20192576373
        • Placido R
        • Cunha Lopes B
        • Almeida AG
        • Rochitte CE
        The role of cardiovascular magnetic resonance in takotsubo syndrome.
        J Cardiovasc Magn Reson. 2016; 18: 68
        • Benouda L
        • Roule V
        • Foucault A
        • Dahdouh Z
        • Lebon A
        • Milliez P.
        Conduction disturbances in takotsubo cardiomyopathy: a cause or a consequence?.
        Int J Cardiol. 2012; 159: 61-62
        • Inayat F
        • Virk HUH
        • Ullah W
        • Riaz I.
        Takotsubo cardiomyopathy-related complete heart block and torsades de pointes.
        BMJ Case Rep. 2017; 2017bcr2016218017