Unknown etiology, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)
Małgorzata Zalewska-Adamiec, Paulina Klonowska, Jolanta Małyszko, Łukasz Kuźma, Hanna Bachorzewska-Gajewska, Sławomir Dobrzycki
Department of Invasive Cardiology, Medical University in Białystok, Białystok, Poland
Am J Case Rep 2021; 22:e930090
Available online: 2021-03-18
The main causes for takotsubo syndrome (TS) in oncological patients are stress related to cancer diagnosis and treatment, pain in the course of the disease, treatment complications, and paraneoplastic syndromes.
CASE REPORT: An obese 62-year-old female patient, with a 3-day history of chest pain, was admitted to the hospital with a suspected acute coronary event. She had been diagnosed with high-grade bladder cancer 6 months before. After the transurethral electroresection of the tumor 5 months before and subsequent chemotherapy (gemcitabine and cisplatin), the patient was qualified for the next cancer surgery. On admission, the patient remained without chest pain. The ECG record demonstrated inverted T waves in the leads from above the anterior and lateral wall. The coronarography demonstrated minor atherosclerotic changes in the coronary arteries. The left ventriculography presented akinesis of the apex and the apical and mid-segment of the anterior wall, and the ejection fraction (EF) was 38%. Takotsubo syndrome was diagnosed. Laboratory testing revealed elevated concentration of troponin and N-terminal pro-B-type natriuretic peptide. The subsequent ECG records demonstrated deeply inverted T waves and numerous ventricular premature beats and increased QTc (528 ms). A control echocardiography showed improved left ventricular contractive function (EF - 47%). On the 4th day of hospitalization, the patient was discharged and referred for further oncological treatment.
CONCLUSIONS: The diagnosis of TS in oncology patients is difficult, especially in the presence of atherosclerotic lesions in coronary arteries. Takotsubo syndrome in cancer patients delays the next stages of oncological treatment, which worsens the prognosis of these patients.
Keywords: Medical Oncology, Neoplasms, Second Primary, takotsubo cardiomyopathy, Urinary Bladder Neoplasms