17 January 2020 : Case report
Reverse Takotsubo Pattern in the Setting of Undiagnosed Pheochromocytoma and Pulmonary Embolism: A Rare Presentation
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathologyN.F.N. Sakul1AEF*, Nikhita R. Balabbigari1EF, Jaskaran K. Purewal1EF, Christian Barrera1F, Roberto Roberti2E
Am J Case Rep 2020; 21:e920231
BACKGROUND: Takotsubo cardiomyopathy is a rare acute cardiac event with varied manifestations characterized by abrupt onset of transient regional dysfunction in a characteristic pattern. A reverse Takotsubo pattern is also well recognized but can also be seen in non-Takotsubo cardiomyopathies.
CASE REPORT: A 23-year-old woman with history of migraines and palpitations presented with nausea, vomiting, pleuritic chest pain, and dyspnea. On initial presentation her vitals were stable and her physical exam was unremarkable. Lab test results were significant for an elevated troponin and D-dimer. An initial CXR was unremarkable. The differential was concerning for pulmonary embolism. Prior to getting a CTA to establish diagnosis, she quickly decompensated. She was emergently intubated due to hypoxia and altered mental status. A repeat CXR showed acute pulmonary edema and repeat lab work showed increasing troponin and creatinine. EKG showed lateral ST depressions the lateral leads and ST elevations in aVL. ECHO showed akinesia of ½ to 2/3rd of proximal LV with a hyperdynamic functioning distal 1/3 LV and an estimated LVEF of 31%, a pattern consistent with reverse Takotsubo. She quickly developed multi-organ failure and, despite aggressive measures, underwent a PEA arrest and was unable to be successfully resuscitated. The autopsy showed hemorrhagic rupture of pheochromocytoma and bilateral thromboemboli of the main pulmonary arteries.
CONCLUSIONS: Reverse Takotsubo variant pattern can be seen in non-Takotsubo cardiomyopathies, and in our patient was noted in the presence of pheochromocytoma and pulmonary embolism. In this scenario, the presence of both would have significantly affected management, if she had not decompensated so quickly.
Keywords: Cardiomyopathies, Catecholamines, Echocardiography, Stress, takotsubo cardiomyopathy, Adrenal Gland Neoplasms, Fatal Outcome, Multiple Organ Failure, Pheochromocytoma, Pulmonary Embolism, Ventricular Dysfunction, Left, young adult
19 May 2022 : Case reportBilateral Emphysematous Pyelonephritis Associated with COVID Pneumonia: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case reportHigh-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case reportA case of exacerbation of haloperidol-induced rhabdomyolysis following the onset of COVID-19
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
24 May 2022 : Case reportAdalimumab Mitigates Lumbar Radiculopathy in a Case of Ankylosing Spondylitis
Am J Case Rep In Press; DOI: 10.12659/AJCR.936600
23 May 2022 : Case reportPharmacological and Behavioral Strategies to Improve Vision in Acquired Pendular Nystagmus
Am J Case Rep In Press; DOI: 10.12659/AJCR.935148
23 May 2022 : Case reportA Case of Methicillin-Sensitive Staphylococcus aureus (MSSA) Prostate Abscess, Osteomyelitis, and Myositis ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936704
Most Viewed Current Articles
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406