Ewha Med J.  2015 Jul;38(2):90-93. 10.12771/emj.2015.38.2.90.

Stress-induced Cardiomyopathy Associated with Non-Small Cell Lung Cancer Presenting as Hyponatremia

• Kim JT
• Seo SH
• Lee SH
• Park DW
• Kang DG
• Lee SU

• KMID: 2052788
• DOI: http://doi.org/10.12771/emj.2015.38.2.90

Abstract

Stress-induced cardiomyopathy, so-called Takotsubo cardiomyopathy, has recently been reported in Japan. Stress-induced cardiomyopathy is characterized by transient left ventricular apical dysfunction and ballooning, with normal coronary angiographic findings. We describe a rare case of stress-induced cardiomyopathy associated with lung adenocarcinoma presenting as hyponatremia.

Keyword

Takotsubo cardiomyopathy; Acute coronary syndrome; Hyponatremia; Inappropriate ADH syndrome; Lung neoplasms

MeSH Terms

Acute Coronary Syndrome
Adenocarcinoma
Carcinoma, Non-Small-Cell Lung*
Cardiomyopathies*
Hyponatremia*
Inappropriate ADH Syndrome
Japan
Lung
Lung Neoplasms
Takotsubo Cardiomyopathy

Figure

• 

  Fig. 1 Electrocardiogram (ECG). (A) ECG obtained two years ago shows sinus rhythm with left ventricular hypertrophy. (B) ECG obtained on arrival shows normal sinus rhythm with T inversion in all the leads.

• 

  Fig. 2 Echocardiography during systole (A) and diastole (B), on the first day of admission. Initial echocardiography reveals left ventricular apical wall motion abnormality and ballooning.

• 

  Fig. 3 Coronary angiogram. Coronary angiogram shows normal left (A) and right (B) coronary arteries.

• 

  Fig. 4 Echocardiogram obtained during systole (A) and diastole (B) on the seventh day after admission. Echocardiogram shows the recovery of the previous wall motion abnormalities.

• 

  Fig. 5 Chest computed tomography image obtained on admission. Chest computed tomography shows an approximately 4.4-cm long, enhancing mass-like consolidation in the right upper lobe of the lung at serial axial image (A) and (B).

• 

  Fig. 6 Biopsy in the right upper lobe with endobronchial ultrasonography guidance. The adenocarcinoma is poorly differentiated. Histologic examination of the lung shows atypical cell proliferation with indistinct glandular structures (H&E, ×200).

Reference

1. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol. 1991; 21:203–214.

2. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352:539–548.

3. Kawai S, Suzuki H, Yamaguchi H, Tanaka K, Sawada H, Aizawa T, et al. Ampulla cardiomyopathy ('Takotusbo' cardiomyopathy): reversible left ventricular dysfunction: with ST segment elevation. Jpn Circ J. 2000; 64:156–159.

4. Lee HH, Gwon HC, Kim BJ, Lee KJ, Im ES, Won KH, et al. Clinical manifestation of novel stress-induced cardiomyopathy mimicking acute myocardial infarction: single center prospective registry. Korean Circ J. 2002; 32:1054–1063.

5. Andrade AA, Stainback RF. Takotsubo cardiomyopathy. Tex Heart Inst J. 2014; 41:299–303.

6. Donohue D, Movahed MR. Clinical characteristics, demographics and prognosis of transient left ventricular apical ballooning syndrome. Heart Fail Rev. 2005; 10:311–316.

7. McDonald P, Lane C, Rojas GE, Masood A. Syndrome of inappropriate anti-diuretic hormone in non-small cell lung carcinoma: a case report. Ecancermedicalscience. 2012; 6:279.

8. Vanhees SL, Paridaens R, Vansteenkiste JF. Syndrome of inappropriate antidiuretic hormone associated with chemotherapyinduced tumour lysis in small-cell lung cancer: case report and literature review. Ann Oncol. 2000; 11:1061–1065.

9. Sorensen JB, Andersen MK, Hansen HH. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. J Intern Med. 1995; 238:97–110.

10. Bose CK, Dey S, Mukhopadhyay A. Hyponatremia of non-small cell lung cancer: Indian experience. Indian J Med Paediatr Oncol. 2011; 32:139–142.