Chonnam Med J.  2013 Aug;49(2):91-95. 10.4068/cmj.2013.49.2.91.

Stress Cardiomyopathy Associated with Diffuse Alveolar Hemorrhage after Colonoscopy

• Hwang JK
• Jang JY
• Kim W

• KMID: 1428270
• DOI: http://doi.org/10.4068/cmj.2013.49.2.91

Abstract

Stress cardiomyopathy (SCM) is usually precipitated by a physiologically or psychologically stressful event. Although it occurs only rarely, hypoxia- and hypercapnia-induced sympathetic activation may also cause SCM. We present the case of a 37-year-old woman affected with SCM after a routine colonoscopy. During the procedure, she aspirated residual polyethylene glycol from her stomach. Hypotension, resting dyspnea, and hemoptysis were subsequently observed. Laboratory findings revealed elevated cardiac enzymes, and a transthoracic echocardiogram revealed left ventricular (LV) global hypokinesia. She was ultimately diagnosed with diffuse alveolar hemorrhage-associated SCM. After successful treatment with a ventilator and corticosteroids, her LV systolic function and dimensions normalized and she was discharged without complications.

Keyword

Cardiomyopathies; Hemorrhage; Polyethylene glycols; Colonoscopy

MeSH Terms

Adrenal Cortex Hormones
Cardiomyopathies
Colonoscopy
Dyspnea
Female
Hemoptysis
Hemorrhage
Humans
Hypokinesia
Hypotension
Life Change Events
Polyethylene Glycols
Stomach
Takotsubo Cardiomyopathy
Ventilators, Mechanical
Adrenal Cortex Hormones
Polyethylene Glycols

Figure

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  FIG. 1 Diagnostic images. (A) Chest radiograph showing multifocal alveolar infiltration; the left upper lung field is especially remarkable. (B) Chest radiograph after 7 days of treatment. (C, D) Chest computed tomography scans with ground-grass attenuation of both upper lobes and the left lower lobe. (E, F) Coronary angiograms indicating no significant stenosis of either coronary artery.

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  FIG. 2 Transthoracic echocardiogram at the time of hospitalization. Basal and midportions of the left ventricle are dilated and hypokinetic. (A, B) Parasternal long-axis view in the systolic and diastolic phase. (C, D) Parasternal short-axis view in the systolic and diastolic phases. (E) The M-mode recoding at the level of the papillary muscle showed a dilated and hypokinetic left ventricle.

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  FIG. 3 Transthoracic echocardiogram 6 months after treatment. Left ventricular systolic function was fully recovered. (A, B) Parasternal long-axis view in the systolic and diastolic phases. (C, D) Parasternal short-axis view in the systolic and diastolic phases. (E) The M-mode recoding also revealed normal systolic function.

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