[A case of status asthmaticus complicated by takotsubo cardiomyopathy]

A 51-year old woman was admitted to our hospital because of status asthmaticus. Electrocardiography (ECG) revealed ST-segment elevation in leads II.III.aVF, and V2 through V6 accompanied by T-wave inversion in leads V3 through V6. The serum levels of creatine kinase, its MB isozyme, and troponin T were slightly elevated, whereas the markedly high levels of serum catecholamine were observed. Despite the ECG changes and elevated cardiac markers, coronary angiography demonstrated normal findings. Left ventriculography revealed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. Methylprednisolone and theophylline were administrated intravenously under mechanical ventilation. The abnormal findings in ECG had improved on day 4 followed by complete recovery from the motional abnormalities of left ventricular wall on day 7. The mechanical ventilation was discontinued on day 15 due to the improvement of respiratory symptoms. Takotsubo cardiomyopathy is a recently described cardiac syndrome that is possibly caused by direct action of excessively released catecholamines on cardiac adrenoceptors when emotional or physical stress is loaded, especially in postmenopausal women. This report has presented a typical case of stress-induced Takotsubo cardiomyopathy in a postmenopausal woman with bronchial asthma.