Takotsubo cardiomyopathy in chronic infection

Takotsubo cardiomyopathy is the acquired, reversible syndrome characterised by apical ballooning and base hypercontractility and probably precipitated by emotional and physical stressors that cause a hyperadrenergic state. It presents as an acute coronary event without there being coronary disease.

We present a case of a 73-year-old woman who developed takotsubo cardiomyopathy with concomitant septic shock from a chronic hemiarthroplasty site infection. The prosthesis had been removed, the surgical site drained twice and multiple antibiotics prescribed. She also had a previous episode of sepsis from she recovered with vasopressor support.

To the author's knowledge, this is the first case of this syndrome occurring in such a prolonged septic process and where the primary focus was a surgical wound. This may indicate continued myocardial injury secondary to a sustained hyperadrenergic state as a possible mechanism for takotsubo cardiomyopathy, rather than a one-time catecholamine surge.