Recurrent apical ballooning despite treatment with verapamil
1Department of Internal Medicine B, Hadassah, Hebrew University Medical Center, Jerusalem, Israel. arami@hadassah.org.il
Cardiology
|November 11, 2006
Summary
Recurrent takotsubo syndrome occurred in a patient despite calcium channel blocker treatment. A microvessel etiology was suggested by a rest thallium scan, indicating potential pathophysiology for this cardiac condition.
Area of Science:
- Cardiology
- Cardiovascular Medicine
Background:
- Takotsubo cardiomyopathy (TTC) is an increasingly recognized condition.
- This case highlights a recurrence of TTC despite standard medical management.
Observation:
- A 76-year-old woman with a history of ischemic heart disease experienced recurrent takotsubo syndrome.
- Initial presentation in 2001 showed apical ballooning consistent with TTC; recovery was noted.
- Recurrence in 2004 presented with similar symptoms but a patent coronary tree, suggesting a non-obstructive cause.
Findings:
- The patient experienced a second episode of apical ballooning (TTC) despite treatment with verapamil, a calcium channel antagonist.
- A rest thallium perfusion scan revealed an isolated, reversible defect in the apex, supporting a microvessel etiology.
- Normalization of cardiac function and ECG occurred rapidly after managing an asthma exacerbation.
Implications:
- This case represents the first reported instance of TTC recurrence while on verapamil therapy.
- The findings suggest a potential microvascular dysfunction as the underlying pathophysiology in some TTC cases.
- Further investigation into microvascular mechanisms is warranted for understanding and managing takotsubo cardiomyopathy.
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