Takutsubo cardiomyopathy and flash pulmonary edema in a trauma patient

First described in Japanese literature in 1991, Takotsubo cardiomyopathy (TCM), or "broken heart" syndrome, continues to be described in novel circumstances. Commonly mistaken for acute coronary syndrome (ACS) due to similar clinical symptoms and electrocardiogram changes, it usually affects postmenopausal women and those in acute emotional or physical stress. Named for the resemblance of apical ballooning and dyskinesis to the Japanese octopus trap, the pathogenesis is poorly understood. Believed to be associated with catecholamine surges during extreme stress, TCM has been reported with grieving, lightning strikes, burns, injuries, and anesthesia. We describe a unique case occurring after a significant motor-vehicle collision (MVC) without apparent injury.

Our aim was to discuss the presentation and management of a cardiac syndrome that can complicate the care of trauma patients by mimicking other life-threatening pathologies.

A 59-year-old healthy female in a rollover MVC was found suspended upside down with her seatbelt across her neck. She was hypoxic, in respiratory distress, and had nonsustained ventricular tachycardia en route. She was dyspneic without pain and had no signs of external trauma. She was assessed with chest x-ray study, focused assessment with sonography in trauma, and electrocardiogram, which demonstrated inferior ST elevation. After negative trauma computed tomography scans, she underwent coronary angiography. Ventriculography revealed apical inferior and anterior ballooning without coronary artery occlusion. She rapidly improved and was discharged in stable condition 2 days later.

TCM presents a diagnostic challenge to the emergency physician. In a patient of this age and mechanism, alternate intrathoracic pathologies, such as ACS, aortic injury, pulmonary contusion, and pneumothorax must be considered.