REVERSE TAKOTSUBO CARDIOMYOPATHY AFTER BLUNT TRAUMA lstlst60@yahoo.com.tw

 

REVERSE TAKOTSUBO CARDIOMYOPATHY AFTER BLUNT TRAUMA

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Taiwan

Oral or Poster

Takotsubo Cardiomyopathy (TTC) is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery disease. Reverse takotsubo, a variant form of takotsubo cardiomyopathy in which the basal and midventricular segments of the left ventricle are akinetic, occurs in a minority of patients. The majority of takotsubo cardiomyopathy patients recover cardiac function within three to six months. While TTC is usually preceded by an emotionally stressful event, physical trauma has been documented as a precipitating incident as well.

Here, we present a case who had reversible takotsubo cardiomyopathy (rTCC) after blunt trauma with cardiac echo video and literature was reviewed.

A 25-year-old female with no past medical history, presented to the emergency department following a motor vehicle collision. Trauma workup was significant for an C5 fracture with spinal cord injury. She underwent emergent operation of C5 corpectomy for nerve decompression and cervical fixation. However, fever with elevated cardiac enzymes, and ST-segment changes were noticed on post-OP day 5. Initial myocarditis was suspected. The patient developed cardiogenic shock and required intra-aortic balloon pump (IABP) support. Bedside echocardiogram revealed LVEF: 33% with LV IVS and proximal 1/2 inferior wall akinetic motion. She underwent cardiac catheterization, which demonstrate no significant coronary artery disease. Stress cardiomyopathy (reverse Takotsubo) was finally diagnosed. IABP was removed on post-OP day 11. The patient recovered uneventfully and discharged smoothly.

Following trauma, signs of ACS in patients should raise provider's suspicion for TTC and prompting bedside echocardiography, which can assist with early diagnosis.