Takotsubo cardiomyopathy associated with bronchoscopic operation: A case report

Takotsubo cardiomyopathy (TTC), a syndrome of acute left ventricular (LV) dysfunction, is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. The symptoms of TTC mimic acute myocardial infarction, without significant coronary stenoses on coronary angiography. Echocardiogram plays a key role in the diagnosis and prognosis of TTC. New indicators from echocardiograms may be helpful in disease evaluation.

A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough. Bronchoscopic lavage, brushing, and biopsy were performed to evaluate tumor progression. During this procedure, he complained of left chest pain, nausea, and vomiting, with elevated troponin levels. Electrocardiogram showed sinus bradycardia with ST-segment elevation in I, AVL, and V4 to V6 leads. Coronary angiography revealed mild stenosis in the right coronary artery. Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. At the 7-d follow-up, echocardiographic pressure-strain analysis showed a normal LV ejection fraction, but partial recovery of LV myocardial work, which fully recovered 5 mo later.

This is a case of TTC caused by bronchoscopic operation. We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.