Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

The Pivotal Role of Echocardiography in the Diagnosis of Stress-Induced Cardiomyopathy Presenting with Atypical Pattern in Critically Ill Children. An Illustrative Case Report

Author(s): Alicia Ramos-Rodriguez, Carmen Fernandez-Bravo, Lorena Estepa-Pedregosa and Moises Rodriguez-Gonzalez*

Volume 18, Issue 9, 2022

Published on: 24 March, 2022

Article ID: e160222201195 Pages: 9

DOI: 10.2174/1573405618666220216121424

Price: $65

Abstract

Background: Takotsubo cardiomyopathy (TCM) has some distinctive features like greater proportion of reverse-TCM and central nervous system disease as a prevalent triggering cause. We expose the case of a child with cardiogenic shock presenting an atypical echocardiographic TCM pattern on an echocardiography, after an acute neurologic trigger. We also include a systematic literature review of previously described cases of atypical-TCM in children.

Case Report: A previously healthy 9 year-old boy with status epilepticus presented abrupt cardiogenic shock. The EKG showed signs of myocardial ischemia, cardiac biomarkers NT-proBNP (2756 pg/mL ) and Troponin I (1707 pg/mL ) , and the echocardiography exposed a dilated LV with severely reduced systolic function (LVEF 28%) along with hypokinetic mid-basal segments (circumferential ballooning), and preserved hypercontractile apical segments, with the normal origin of both coronary arterial systems. A presumptive diagnosis of “reverse”, “inverse” or atypical Takotsubo cardiomyopathy was built based on the echocardiographic findings, apart from the ACS-like EKG findings, the raised cardiac biomarkers, and the neurological trigger of the hyper catecholaminergic state. Despite cardiovascular improvement with supportive treatment, the patient eventually expired on day 2 after PICU admission due to neurological complications. As shown in our systematic review, only 19 similar cases have been reported to date.

Conclusion: With the report of this unusual case, we aim to point out the fundamental role of bedside echocardiography as a diagnostic test for critically ill children presenting with ACS-like in the context of neurosurgical emergencies, where bedside echocardiography itself can accurately establish a presumptive diagnosis of TCM.

Keywords: Takotsubo cardiomyopathy, stress-induced cardiomyopathy, acute coronary syndrome, status epilepticus, point of care ultrasonography, electrocardiographic.

Graphical Abstract

[1]
Bybee KA, Prasad A. Stress-Related cardiomyopathy syndromes. Circulation 2008; 118(4): 677625.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.106.677625]
[2]
Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy-a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc 2008; 5(1): 22-9.
[http://dx.doi.org/10.1038/ncpcardio1066]
[3]
Hernandez LE. Takotsubo cardiomyopathy: How much do we know of this syndrome in children and young adults? Cardiol Young 2014; 24(4): 580-92.
[http://dx.doi.org/10.1017/S1047951114000080]
[4]
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373.
[http://dx.doi.org/10.1056/NEJMoa1406761]
[5]
Redfors B, Shao Y, Lyon AR, Omerovic E. Diagnostic criteria for takotsubo syndrome: A call for consensus. Int J Cardiol 2014; 176(1): 274-6.
[http://dx.doi.org/10.1016/j.ijcard.2014.06.094]
[6]
Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of takotsubo syndrome. Nat Rev Cardiol 2015; 12(7): 387-97.
[http://dx.doi.org/10.1038/nrcardio.2015.39]
[7]
Madhavan M, Prasad A. Proposed mayo clinic criteria for the diagnosis of tako-tsubo cardiomyopathy and long-term prognosis. Herz 2010; 35(4): 240-3.
[http://dx.doi.org/10.1007/s00059-010-3339-x]
[8]
Lyon AR, Bossone E, Schneider B, et al. Current state of knowledge on takotsubo syndrome: A position statement from the taskforce on takotsubo syndrome of the heart failure association of the european society of cardiology: Current state of knowledge on takotsubo syn-drome. Eur J Heart Fail 2016; 18(1): 8-27.
[http://dx.doi.org/10.1002/ejhf.424]
[9]
Van de Walle SOA, Gevaert SA, Gheeraert PJ, De Pauw M, Gillebert TC. Transient stress-induced cardiomyopathy with an “Inverted Tako-tsubo” contractile pattern. Mayo Clin Proc 2006; 81(11): 1499-502.
[http://dx.doi.org/10.4065/81.11.1499]
[10]
Cacciotti L, Camastra GS, Beni S, et al. A new variant of Tako-tsubo cardiomyopathy: Transient mid-ventricular ballooning. J Cardiovasc Med 2007; 8(12): 1052-4.
[http://dx.doi.org/10.2459/JCM.0b013e32803cab4a]
[11]
Ramaraj R, Movahed MR. Reverse or inverted takotsubo cardiomyopathy (Reverse Left Ventricular Apical Ballooning Syndrome) Presents at a Younger age compared with the mid or apical variant and is always associated with triggering stress: Inverted takotsubo different entity. Congest Heart Fail 2010; 16(6): 284-6.
[http://dx.doi.org/10.1111/j.1751-7133.2010.00188.x]
[12]
Song BG, Chun WJ, Park YH. The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted takotsubo cardiomyopathy: Comparison with mid or apical variant. Clin Cardiol 2011; 34(11): 693-9.
[http://dx.doi.org/10.1002/clc.20953]
[13]
Sendi P, Martinez P, Chegondi M, Totapally BR. Takotsubo cardiomyopathy in children. Cardiol Young 2020; 30(11): 1711-5.
[http://dx.doi.org/10.1017/S1047951120002632]
[14]
Topal Y, Topal H. Doğan C, Tiryaki S B, Biteker M. Takotsubo (stress) cardiomyopathy in childhood. Eur J Pediatr 2019; 179(4): 619-25.
[http://dx.doi.org/10.1007/s00431-019-03536-z]
[15]
Koyama J, Akutsu N, Kawamura A. Pediatric takotsubo syndrome caused by hydrocephalus after posterior fossa tumor surgery. Childs Nerv Syst 2021; 37: 3957-61.
[http://dx.doi.org/10.1007/s00381-021-05090-2]
[16]
Johnson J, Ragheb J, Garg R, Patten W, Sandberg DI, Bhatia S. Neurogenic stunned myocardium after acute hydrocephalus: Report of 2 cases. J Neurosurg Pediatr 2010; 5(5): 428-33.
[http://dx.doi.org/10.3171/2009.11.PEDS09341]
[17]
Paur H, Wright PT, Sikkel MB, et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: A new model of takotsubo cardiomyopathy. Circulation 2012; 126(6): 697-706.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.112.111591] [PMID: 22732314]
[18]
Burgdorf C. Regional alterations in myocardial sympathetic innervation in patients with transient left-ventricular apical ballooning (Tako-Tsubo cardiomyopathy). J Nucl Cardiol 2008; 15(1): 2007.
[http://dx.doi.org/10.1016/j.nuclcard.2007.08.005]
[19]
Hravnak M. Elevated cardiac troponin I and relationship to persistence of electrocardiographic and echocardiographic abnormalities after aneurysmal subarachnoid hemorrhage. Stroke 2009; 40(11): 556753.
[http://dx.doi.org/10.1161/STROKEAHA.109.556753]
[20]
Guglin M, Novotorova I. Neurogenic stunned myocardium and takotsubo cardiomyopathy are the same syndrome: A pooled analysis: Neu-rogenic stunned myocardium and takotsubo cardiomyopathy. Congest Heart Fail 2011; 17(3): 1751-7133.
[http://dx.doi.org/10.1111/j.1751-7133.2011.00210.x]
[21]
Chockalingam A. Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms. Indian Heart J 2018; 70(1): 005.
[http://dx.doi.org/10.1016/j.ihj.2017.04.005]
[22]
Morris N A. The risk of takotsubo cardiomyopathy in acute neurological disease. Neurocrit Care 2019; 30(1): 018-0591.
[http://dx.doi.org/10.1007/s12028-018-0591-z]
[23]
Madias JE. Bradycardia and hypotension in a patient with subarachnoid hemorrhage-triggered takotsubo syndrome. Int J Cardiol 2016; 212: 296.
[http://dx.doi.org/10.1016/j.ijcard.2016.03.161] [PMID: 27057943]
[24]
Desai R. Frequency of takotsubo cardiomyopathy in epilepsy-related hospitalizations among adults and its impact on in-hospital outcomes: A national standpoint. Int J Cardiol 2020; 299: 67-70.
[http://dx.doi.org/10.1016/j.ijcard.2019.07.034]
[25]
Muratsu A, Muroya T, Kuwagata Y. Takotsubo cardiomyopathy in the intensive care unit. Acute Med Surg 2019; 6(2): 396.
[http://dx.doi.org/10.1002/ams2.396]
[26]
Waller CJ, Vandenberg B, Hasan D, Kumar AB. Stress cardiomyopathy with an “Inverse” takotsubo pattern in a patient with acute aneu-rysmal subarachnoid hemorrhage. Echocardiography 2013; 30(8): 12266.
[http://dx.doi.org/10.1111/echo.12266]
[27]
Varghese J G, Jelani Q, Zarich S, Walsh B. The role of early focused cardiac ultrasound in a not-so-typical presentation of takotsubo cardiomyopathy: A case report. J Emerg Med 2017; 52(5): 024.
[http://dx.doi.org/10.1016/j.jemermed.2017.01.024]
[28]
Meigh K. Takotsubo cardiomyopathy in the emergency department: A focus heart breaker. Clin Pract Cases Emerg Med 2018; 2(2): 37291.
[http://dx.doi.org/10.5811/cpcem.2018.2.37291]
[29]
Ennezat PV. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: A novel heart syndrome (Inverted Takotsubo): Transient left ventricular basal dysfunction. Echocardiography 2005; 22(7): 40046.
[http://dx.doi.org/10.1111/j.1540-8175.2005.40046.x]
[30]
Barnicle R, Bracey A, Secko M. Early identification of takotsubo syndrome in the emergency department using point-of-care echocardiog-raphy: A case series. J Clin Ultrasound 2020; 49(4): 413-9.
[http://dx.doi.org/10.1002/jcu.22918]
[31]
Dastidar AG, Rodrigues JCL, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc 2015; 8(8): 9345.
[http://dx.doi.org/10.1007/s12410-015-9345-x]
[32]
Abbas A, Sonnex E, Pereira RS, Coulden RA. Cardiac magnetic resonance assessment of takotsubo cardiomyopathy. Clin Radiol 2016; 71(1): 020.
[http://dx.doi.org/10.1016/j.crad.2015.10.020]
[33]
Agewall S. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2017; 38(3): 143-53.
[http://dx.doi.org/10.1093/eurheartj/ehw149] [PMID: 28158518]
[34]
Mansencal N, El Mahmoud R, Pillière R, Dubourg O. Relationship between pattern of tako-tsubo cardiomyopathy and age: From midventricular to apical ballooning syndrome. Int J Cardiol 2010; 138(1): 009.
[http://dx.doi.org/10.1016/j.ijcard.2008.06.009]
[35]
Fu KX, Ng BHZ, Chua MHX. A unique case of acute brain haemorrhage with left ventricular systolic failure requiring ECMO. BMC Pediatr 2019; 19(1): 1658-5.
[http://dx.doi.org/10.1186/s12887-019-1658-5]
[36]
Toce MS, Farias M, Bruccoleri R, Brown DW, Burns MM. A case report of reversible takotsubo cardiomyopathy after ampheta-mine/dextroamphetamine ingestion in a 15-year-old adolescent girl. J Pediatr 2017; 182: 385-388.e3.
[http://dx.doi.org/10.1016/j.jpeds.2016.11.038] [PMID: 27979580]
[37]
Urbinati A, Pellicori P, Guerra F, Capucci A, Clark AL. Takotsubo syndrome in the paediatric population: A case report and a systematic review. J Cardiovasc Med 2017; 18(4): 262-7.
[http://dx.doi.org/10.2459/JCM.0000000000000446]
[38]
Oliveira J F. Stunned myocardium after an anesthetic procedure in a pediatric patient - case report. 2016; 36(6): 026.
[http://dx.doi.org/10.1016/j.repce.2015.09.026]
[39]
Alados Arboledas FJ, Millán-Miralles L, Millán-Bueno MP, Expósito-Montes JF, Santiago-Gutierrez C, Martínez Padilla MC. Neurogenic stunned myocardium in Pediatrics. A case report. Rev Esp Anestesiol Reanim 2015; 62(8): 472-6.
[http://dx.doi.org/10.1016/j.redar.2014.10.010]
[40]
Sharkey SW, McAllister N, Dassenko D, Lin D, Han K, Maron BJ. Evidence that high catecholamine levels produced by pheochromocyto-ma may be responsible for tako-tsubo cardiomyopathy. Am J Cardiol 2015; 115(11): 1615-8.
[http://dx.doi.org/10.1016/j.amjcard.2015.02.069]
[41]
Wittekind SG, Yanay O, Johnson EM, Gibbons EF. Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hem-orrhage. Pediatrics 2014; 134(4): 1211-7.
[http://dx.doi.org/10.1542/peds.2013-1881]
[42]
Al-Abri S, Meier KH, Colby JM, Smollin CG, Benowitz NL. Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels. Clin Toxicol 2014; 52(10): 1292-5.
[http://dx.doi.org/10.3109/15563650.2014.974262]
[43]
Schimpf R, Meinhardt J, Borggrefe M, Haghi D. Catecholaminergic polymorphic ventricular tachycardia and midventricular Takotsubo car-diomyopathy: A novel association? Herzschrittmacherther Elektrophysiol 2013; 24(1): 63-6.
[http://dx.doi.org/10.1007/s00399-013-0248-8]
[44]
De Rosa G. Neurogenic stunned myocardium presenting as left ventricular hypertrabeculation in childhood: A variant of takotsubo cardio-myopathy? Pediatr Crit Care Med 2011; 12(6): 420-3.
[http://dx.doi.org/10.1097/PCC.0b013e3182192944]
[45]
Olivotti L, Moshiri S, Nicolino A, Chiarella F. Stress cardiomyopathy and arrhythmic storm in a 14-year-old boy. J Cardiovasc Med 2010; 11(7): 519-21.
[http://dx.doi.org/10.2459/JCM.0b013e328330ebf8]
[46]
Bajolle F, Basquin A, Lucron H, Bonnet D. Acute ischemic cardiomyopathy after extreme emotional stress in a child. Congenit Heart Dis 2009; 4(5): 387-90.
[http://dx.doi.org/10.1111/j.1747-0803.2009.00277.x]

Rights & Permissions Print Cite
Article Metrics
33
1
© 2024 Bentham Science Publishers | Privacy Policy