Severe heatstroke complicated with Takotsubo cardiomyopathy.

Area of Science:

• Emergency Medicine
• Cardiology
• Environmental Health

Background:

• Heatstroke is a life-threatening condition characterized by hyperthermia and central nervous system dysfunction.
• Takotsubo cardiomyopathy, or stress-induced cardiomyopathy, presents with symptoms mimicking myocardial infarction.

Observation:

• A 69-year-old female with schizophrenia presented with coma, hypotension, and severe hyperthermia (40°C).
• Initial assessment revealed ST elevation on EKG and apical ballooning on echocardiography, indicative of Takotsubo cardiomyopathy.
• Coronary angiography showed normal coronary arteries, ruling out obstructive coronary artery disease.

Findings:

• The patient's presentation strongly suggested heatstroke as the precipitating event for Takotsubo cardiomyopathy.
• Active cooling measures and fluid resuscitation were initiated upon presentation.
• Cardiovascular status gradually improved, leading to transfer from the ICU on day 36.

Implications:

• Heatstroke and Takotsubo cardiomyopathy share overlapping pathophysiological mechanisms, particularly related to catecholamine surge and myocardial stunning.
• Close hemodynamic monitoring and assessment for myocardial damage are crucial for managing patients with severe heatstroke.
• This case highlights the importance of considering cardiac complications in patients with heatstroke.