1. REVERSE TAKOTSUBO CARDIOMYOPATHY IN AN ELDERLY PATIENT WITH BACTEREMIA
Capt Debra Koenigsberger, USAF, MC David Grant Medical Center, Travis AFB, CA
INTRODUCTION
DISCUSSION
Reverse takotsubo cardiomyopathy (RTCM):
Subtype of stress cardiomyopathy
Transient hyperdynamic apex with akinetic base
Typically affects the young and healthy
Associated with exogenous catecholamine exposure
Often presents w/ anginal chest pain and dyspnea
Troponin elevation often noted
ST elevation on EKG often seen
Normal coronary arteries on cardiac cath
RTCM incidence increasing in literature with atypical features:
Advanced age
Subtle symptoms
Endogenous hyperadrenergic state
Important to consider in critically ill patients:
Prevent unnecessary fluid boluses
Optimize medical therapy
Ensure proper monitoring
Tailor medications to prevent torsades
Cardiac cath showing normal filling pattern during diastole
CONCLUSION
PATIENT CASE
Patient’s symptoms resolved and EF normalized on repeat echo 24 hours later
Outpatient medications optimized for continued treatment of cardiomyopathy
RTCM can present atypically and subtly in older patients
Early recognition facilitates targeted management of heart failure and cardiogenic shock
67 yo F with metastatic breast cancer
Neutropenic fever, MSSA bacteremia
Dyspnea, tachycardia, high BP on HD #2
No chest pain
EKG with ST-elevation, troponin 0.78
Cardiac cath:
No acute thrombus or vasospasm
Anterior and inferior hypokinetic base
EF of 45%
Hyperdynamic apex during systole
Classic takotsubo cardiomyopathy: hyperdynamic base, apical ballooning
"The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force."