Letter to the EditorTransient left ventricular apical ballooning syndrome following a hyponatraemic seizure
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.
References (6)
- et al.
Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan
J Am Coll Cardiol
(2001) - et al.
Water and sodium disturbances predict prognosis of acute disease in long term cared frail elderly
Arch Gerontol Geriatr
(2005) - et al.
Takotsubo –type cardiomyopathy due to multivessel spasm
Cited by (22)
Immediate versus delayed detection of Takotsubo syndrome after epileptic seizures
2019, Journal of the Neurological SciencesCitation Excerpt :Most articles were reports about a single case, 5 articles comprised case series [17–21]. In 23 cases, TTS was reported to develop immediately after the seizure and signs of TTS were already present at hospital admission (Table 1) [4–6,8,9,13,14,16,20–34]. In the remaining 25 cases, detection of TTS was reported 5–288 (mean 50) hours after the seizure (Table 2) [3,10–12,17–19,35–49].
Hyponatremia-induced stress cardiomyopathy due to psychogenic polydipsia
2016, International Journal of CardiologyBland and broken hearted: A case of hyponatremia induced Tako-tsubo cardiomyopathy
2015, International Journal of CardiologyCNS disease triggering Takotsubo stress cardiomyopathy
2014, International Journal of CardiologyCitation Excerpt :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].
Takotsubo cardiomyopathy and endocrine disorders: A mini-review of case reports
2014, American Journal of Emergency Medicine