Takotsubo cardiomyopathy associated with status epilepticus

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Seow SC, Lee YP, Teo SG, Hong ECT, and Lee CH (2008) Takotsubo cardiomyopathy associated with status epilepticus. Eur J Neurol p. e46.

Link to Article

First Paragraph: A 62-year-old Chinese male with no previous history of seizures was admitted with status epilepticus necessitating intravenous lorazepam, propofol and endotracheal intubation. He became hypotensive and an ECG showed ST-segment elevation in the anterior precordial leads. Cardiac enzymes were elevated. He did not have any cardiovascular risk factors. Bedside echocardiogram showed mildly impaired left ventricular ejection fraction of 40% with mid-ventricular ballooning and relative sparing of the apex. Coronary angiogram revealed a non-significant stenosis in the obtuse marginal branch of the left circumflex artery. A diagnosis of Takotsubo (stress-induced) cardiomyopathy was made. The patient subsequently made an uneventful cardiac recovery. Repeat echocardiogram 6 weeks later was normal. MRI of the brain showed encephalomalacia of the right basal frontal lobe with old lacunas in bilateral external capsules, bilateral corona radiata and right hemipons.

Keywords: apical ballooning, status epilepticus, Takotsubo cardiomyopathy

Context

  • Letter to the editor single-case report of Takotsubo cardiomyopathy – midsystolic apical ballooning – detected on echocardiography in a patient who had developed EKG changes and hypotension during status epilepticus. The authors state that this acute cardiomyopathy is “thought to be due to catecholamine-induced coronary microcirculatory spasm,” suggesting that in this patient with no cardiovascular risk factors the onset of status epilepticus may have produced a significant increase in circulatory catecholamines.

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