Takotsubo cardiomyopathy associated with diving

Takotsubo cardiomyopathy consists of cardiomyopathy with transient apical ballooning and left ventricular systolic dysfunction in the absence of atheromatous disease of the coronary arteries, accompanied by ECG changes together with elevated cardiac enzymes appearing in a context of emotional or physical stress. A 51-year-old woman was referred to our emergency department for treatment after chest pain associated with acute dyspnoea during diving. On questioning, the patient confirmed that she had twice dived to 35 m without any missed decompression stops and informed us that she had experienced tightening of the chest followed by sudden dyspnoea during her second ascent in a setting of marked emotional stress since the previous evening. Her ECG showed inverted T-waves in DI, aVL, V1 and V2, whereas chest radiographs revealed bilateral infiltration of the lower half of the lung fields and a globular heart. Laboratory tests revealed: troponin Ic 7.49 μg/l, myoglobin 206 μg/l, creatine phosphokinase 341 IU/l and N-terminal prohormone brain natriuretic peptide 7919 ng/l. Echocardiography performed in the emergency department showed left ventricular hypokinesia in the medioapical segment with an appearance of apical ballooning, hyperkinesia of the basal portion and a left ventricular ejection fraction of 35%. Coronary angiography revealed healthy coronary arteries. In conclusion, diagnosis of takotsubo cardiomyopathy is based on the guidelines issued at a consensus conference of the Idiopathic Cardiomyopathy Research Committee. This case shows the possibility of this syndrome occurring while diving.