J Cardiovasc Ultrasound.  2015 Dec;23(4):262-265. 10.4250/jcu.2015.23.4.262.

Biventricular Takotsubo Cardiomyopathy Associated with Epilepsy

• Koo N
• Yoon BW
• Song Y
• Lee CK
• Lee TY
• Hong JY

• KMID: 2144458
• DOI: http://doi.org/10.4250/jcu.2015.23.4.262

Abstract

We describe a case of Takotsubo cardiomyopathy in an elderly woman after status epilepticus. In an emergency echocardiography, not only left ventricular apical ballooning but also right ventricular apical hypokinesia was observed. After a medical management, the patient's condition was improved and a follow-up echocardiography showed substantial recovery of left and right ventricular apical ballooning.

Keyword

Biventricular Takotsubo cardiomyopathy; Stress-induced cardiomyopathy; Epilepsy; Status epilepticus

MeSH Terms

Aged
Echocardiography
Emergencies
Epilepsy*
Female
Follow-Up Studies
Humans
Hypokinesia
Status Epilepticus
Takotsubo Cardiomyopathy*

Figure

• 

  Fig. 1 Chest radiograph showed cardiomegaly and patchy increased opacities in right upper and lower lobes.

• 

  Fig. 2 Electrocardiography demonstrated precordial V2-4 ST segment elevation.

• 

  Fig. 3 Transthoracic echocardiography at admission. Apical ballooning of left ventricle was seen in diastolic apical 4 chamber view (A) and diastolic expanded apical 4 chamber (B). In diastolic modified apical 4 chamber view (C), right ventricle also seemed like ballooning of apex. In systole (D, E, and F) apex of right ventricle was hypokinetic (arrows) and basal right ventricle relatively seen to be over-contractile (arrows). LV: left ventricle, RV: right ventricular, RA: right atrium, LA: left atrium.

• 

  Fig. 4 Coronary angiography. There was no significant lesion of right coronary artery (RCA). In left coronary artery, ramus intermedius artery (RI) had significant stenosis, but left anterior descending artery (LAD) had no significant stenosis. LCX: left circumflex artery.

• 

  Fig. 5 Transthoracic echocardiography before discharge. In diastole (A and B), apex of left ventricle was not seen to be ballooning and contractility (arrow) of apical right ventricle was improved in systole (C and D). LV: left ventricle, RV: right ventricular, RA: right atrium, LA: left atrium, LVOT: left ventricular outflow tract.

Reference

1. Ako J, Sudhir K, Farouque HM, Honda Y, Fitzgerald PJ. Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited. Am J Med. 2006; 119:10–17.

2. Ohtsuka T, Hamada M, Kodama K, Sasaki O, Suzuki M, Hara Y, Shigematsu Y, Hiwada K. Images in Cardiovascular Medicine. Neurogenic stunned myocardium. Circulation. 2000; 101:2122–2124.

3. Stöllberger C, Huber JO, Enzelsberger B, Finsterer J. Fatal outcome of epileptic seizure-induced takotsubo syndrome with left ventricular rupture. Eur J Neurol. 2009; 16:e116–e117.

4. Schneider F, Kadel C, Pagitz M, Sen S. Takotsubo cardiomyopathy and elevated troponin levels following cerebral seizure. Int J Cardiol. 2010; 145:586–587.

5. Daoko J, Rajachandran M, Savarese R, Orme J. Biventricular takotsubo cardiomyopathy: case study and review of literature. Tex Heart Inst J. 2013; 40:305–311.

6. Sato H, Tateishi H, Uchida T, Dote K, Ishihara M. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In : Kodama K, Haze K, Hori M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyoronsya;1990. p. 56–64.

7. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006; 27:1523–1529.

8. Yun MH, Choi S, Park JY, Kim CH, Beom JW, Park G, Kim SH. Coincident takotsubo cardiomyopathy and coronary artery disease. Korean J Med. 2012; 83:791–795.

9. Yoshikawa T. Takotsubo cardiomyopathy, a new concept of cardiomyopathy: clinical features and pathophysiology. Int J Cardiol. 2015; 182:297–303.

10. Meierkord H, Shorvon S, Lightman SL. Plasma concentrations of prolactin, noradrenaline, vasopressin and oxytocin during and after a prolonged epileptic seizure. Acta Neurol Scand. 1994; 90:73–77.

11. Simon RP, Aminoff MJ, Benowitz NL. Changes in plasma catecholamines after tonic-clonic seizures. Neurology. 1984; 34:255–257.

12. Shimizu M, Kagawa A, Takano T, Masai H, Miwa Y. Neurogenic stunned myocardium associated with status epileptics and postictal catecholamine surge. Intern Med. 2008; 47:269–273.

13. Lee JW, Kim JY, Youn YJ, Sung JK, Lee NS, Lee KH, Yoo BS, Lee SH, Yoon J, Choe KH. Clinical characteristics and prognostic factors of stress-induced cardiomyopathy. Korean Circ J. 2010; 40:277–282.

14. Le Ven F, Pennec PY, Timsit S, Blanc JJ. Takotsubo syndrome associated with seizures: an underestimated cause of sudden death in epilepsy? Int J Cardiol. 2011; 146:475–479.

15. Haghi D, Athanasiadis A, Papavassiliu T, Suselbeck T, Fluechter S, Mahrholdt H, Borggrefe M, Sechtem U. Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J. 2006; 27:2433–2439.