Document Detail

Takotsubo cardiomyopathy associated with hypoglycemia: inverted takotsubo contractile pattern.
MedLine Citation:
PMID:  22425000     Owner:  NLM     Status:  MEDLINE    
Classic takotsubo cardiomyopathy (TCM) is characterized by transient dysfunction of the apical portion of the left ventricle with hyperkinesis of the other parts of the heart wall. Recently, wall motion abnormalities in parts other than in the apical portion of the heart have been reported. Inverted TCM is one form of these anomalies. In this form, the basal segments rather than the apical part of the heart are akinetic/dyskinetic, and the apex is hyperdynamic. Emotional or physical stress is known to trigger TCM, leading some authors to call TCM stress-induced cardiomyopathy (SC). Hypoglycemia is regarded as one of the physical stresses that cause TCM/SC. We present a case of inverted TCM/SC with hypoglycemia. In this case, a 60-year-old woman was brought to our hospital with loss of consciousness caused by hypoglycemia. Initially, the echocardiography revealed an inverted takotsubo contractile pattern. The patient was stabilized with continuous intravenous fluids and a glucose injection, whereas the echocardiography on day 4 showed an almost normal contractile pattern. Among the case reports regarding hypoglycemia as a preceding stressor of TCM/SC, a case of inverted TCM/SC with hypoglycemia is rare. Hypoglycemia is a relatively common case in emergency department; however wall motion abnormalities are not usually expected in hypoglycemic patients. Thus, undiagnosed self-limited TCM/SC cases are possible among hypoglycemic patients. TCM/SC is reported to be a cause of torsade de pointes, which can be fatal. This might warrant an echocardiogram for hypoglycemic patients so as not to overlook TCM/SC in the emergency department.
Shungo Katoh; Yoichi Yamada; Rikiya Shinohe; Kenji Aoki; Masahiko Abe
Publication Detail:
Type:  Case Reports; Journal Article; Video-Audio Media     Date:  2012-03-16
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  30     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-03-12     Revised Date:  2013-04-16    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2098.e1-3     Citation Subset:  IM    
Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan.
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MeSH Terms
Emergency Service, Hospital
Heart / physiopathology
Hypoglycemia / complications*,  physiopathology
Middle Aged
Takotsubo Cardiomyopathy / etiology*,  physiopathology,  ultrasonography
Comment In:
Am J Emerg Med. 2013 Mar;31(3):630   [PMID:  23347712 ]

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