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Takotsubo cardiomyopathy as a sequela of elective direct-current cardioversion for atrial fibrillation
Jonathan S Siegfried1, Satjit Bhusri1, Nils Guttenplan1
1Department of Cardiovascular Medicine, Lenox Hill Hospital, New York, NY 10021.
Insights
Takotsubo cardiomyopathy, mimicking heart attack without artery blockage, can be triggered by stress. This case highlights a potential link between cardioversion for atrial fibrillation and this condition, with full recovery observed.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Internal Medicine
Background:
- Takotsubo cardiomyopathy presents as acute myocardial infarction without obstructive coronary artery disease.
- It is often triggered by significant physical or psychological stress.
- The underlying mechanism is hypothesized to involve catecholamine excess.
Abstract:
In takotsubo cardiomyopathy, the clinical appearance is that of an acute myocardial infarction in the absence of obstructive coronary artery disease, with apical ballooning of the left ventricle. The condition is usually precipitated by a stressful physical or psychological experience. The mechanism is unknown but is thought to be related to catecholamine excess. We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardio-version for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery. In addition to this case, we discuss the possible direct effect of cardioversion in takotsubo cardiomyopathy.
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