Letter to the Editor
Transient left ventricular apical ballooning syndrome following a hyponatraemic seizure

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Introduction

Transient left ventricular apical ballooning syndrome (TLVABS) was initially described in Japan in the early 1990's [1] and was called Takotsubo-type cardiomyopathy. Tako-tsubo is Japanese for octopus pot or trap, which resembles the left ventricular apical ballooning seen with this condition. This disorder is characterized by chest pain, anterior ST segment elevation, reversible left ventricular apical dyskinesis, minimal cardiac enzyme rise and smooth ‘normal’ coronary arteries [2].

This aim of this article is to discuss the first case report of TLVABS following a seizure.

Section snippets

Case report

The patient is a 69 year old lady who presented to emergency department with increasing confusion and a recent generalized tonic/clonic seizure. She, in recent years, had become progressively debilitated from a 35 year history of multiple sclerosis. Over the preceding 1–2 years she was increasingly dependent on her activities of daily living and was wheelchair bound with a permanent indwelling urinary catheter. She was recently treated with a course of antibiotics for a urinary tract infection

Discussion

This case raises a number of important issues, not only in relation to her TLVABS but also the aetiology of her hyponatraemia.

Hyponatraemia is a common condition in the elderly debilitated patient [3]. However, the severity of the hyponatraemia seen in this patient probably reflects multiple contributing factors. These include venlefaxine and dehydration following a febrile illness [3]. Indeed the serum and urine biochemistry results suggest a syndrome of inappropriate antidiuretic hormone

Conclusions

Transient left ventricular apical ballooning syndrome is a rare disorder that mimics a ST segment elevation myocardial infarction. While mortality rates are low with this condition, early β-blocker use in this group is advised. The aetiology of this condition likely relates to a ‘sympathetic surge’ brought on by emotional or physical stress including an epileptic seizure.

Acknowledgments

Dr. Worthley is supported with a Royal Australasian College of Physicians Research Fellowship. Dr. Anderson is a Scholar of the Alberta Heritage Foundation for Medical Research.

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References (6)

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    Three of these patients were female and two male. The most frequent cardiac complication of ALS is thus TTS [13–132]. So far, only in five cases was traumatic CNS injury associated with TTS [31,133–136].

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