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Pericarditis in Takotsubo Cardiomyopathy: A Case Report and Review of the Literature

DOI: 10.1155/2013/917851

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Abstract:

Case. A 64-year-old Caucasian woman was brought to the emergency department with severe dysphagia and left chest pain for last 4?days. Initial evaluation revealed elevated ST segment in precordial leads on EKG with elevated cardiac enzymes. Limited echocardiogram showed infra-apical wall hypokinesia. Cardiac angiography was done subsequently which showed nonflow limiting mild coronary artery disease. Takotsubo cardiomyopathy was diagnosed and she was treated medically. On the third day of admission, a repeat ECG showed diffuse convex ST-segment elevations in precordial leads, compatible with acute pericarditis pattern of EKG. Decision was made to start colchicine empirically for possible pericarditis. Follow-up EKG in 2?days showed decreased ST-segment elevations in precordial leads. The patient was discharged with colchicine and a follow-up echocardiogram in 4?weeks demonstrated a normal ejection fraction with no evidence of pericarditis. Conclusion. Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy. It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy. 1. Introduction Takotsubo cardiomyopathy (TC), also known as transient apical ballooning syndrome or broken heart syndrome, is a sudden onset nonischemic cardiomyopathy that causes akinesis of the left midventricle and apex. Patients usually present with acute chest pain and ST segment elevation on ECG that mimics an acute coronary syndrome. The prognosis of TC is mostly favorable. However, serious complications can occur including cardiogenic shock, ventricular rupture, dysrhythmia, and pericarditis [1]. The relationship between TC and pericarditis has not been clearly identified. Here we report a case of Takotsubo cardiomyopathy that was possibly complicated with asymptomatic pericarditis. 2. Case Presentation A 64-year-old Caucasian woman was brought to the emergency department after being found confused. She had been feeling nauseated and was unable to keep anything down due to severe dysphagia for the last 4 days. She also reported that she had been having left side chest pain for the last 3-4 days, and it became much worse on the day of presentation. She was a long-term smoker and had a history of hypertension, dyslipidemia, insulin-dependent diabetes, and depression. The initial electrocardiogram (ECG) revealed a normal sinus rhythm and ST-segment elevation in leads V2 to V4, II, III, and aVF (Figure 1). The bedside echocardiogram showed anterior wall hypokinesis. Her

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