TWO VARIANTS OF TAKOTSUBO CARDIOMYOPATHY IN A YOUNG WOMAN WITH ALCOHOL WITHDRAWAL
Mohammed M, Sirdenis N, Gorgis S, Azzo Z, and Parikh S. TWO VARIANTS OF TAKOTSUBO CARDIOMYOPATHY IN A YOUNG WOMAN WITH ALCOHOL WITHDRAWAL. Journal of the American College of Cardiology 2021; 77(18):2250.
Journal of the American College of Cardiology
Background: Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction and often mimics acute coronary syndrome. Although there are four echocardiographic patterns of TCM, patients typically present with one variant.
Case: A 32-year-old woman with alcohol use disorder presented with shortness of breath, nausea, vomiting, and malaise. She had tremors concerning for alcohol withdrawal and was found to be hypoxic with a chest X-ray showing pulmonary edema. She had elevated troponin, BNP, and lactate. Electrocardiogram showed no ischemic changes. The patient developed acute respiratory failure and required intubation. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 22% with global hypokinesis of the left ventricle, apical ballooning and preserved basal function. Cardiac catheterization showed no coronary artery disease.
Decision-making: The patient made hemodynamic and symptomatic improvement and in three days the EF improved to 50%. She was diagnosed with classical TCM in the setting of alcohol withdrawal. Four months after the initial presentation, she presented again with palpitations, diaphoresis, tremors and sharp chest pain. The patient reported alcohol cessation for three days following two months of heavy alcohol use. She had elevated BNP, troponin and lactate. Electrocardiogram showed ST segment depression in leads V3-V5. TTE showed an EF of 38% with severe hypokinesis of basal to mid left ventricular wall consistent with reverse TCM. The patient was treated for acute decompensated heart failure in the setting of alcohol withdrawal and had symptomatic improvement in few days.
Conclusion: TCM has been described to occur in various morphologies but only rare cases have shown multiple variants in one individual. We present a rare case of one patient with two distinct variants of TCM during two separate episodes of alcohol withdrawal. Although the mechanism is unclear, we suspect that the combination of genetic predisposition and adrenergic response in substance abuse may play a role in our case.