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Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion
Abel Murguía-Aranda1, Jorge A Castañón-González1,2, Mario Shuchleib-Cukiert1
1Department of Cardiology, Hospital ABC, Hospital Juárez de México. Mexico City, Mexico.
Insights
Takotsubo syndrome, a reversible heart condition, occurred in an 85-year-old woman with severe hyponatremia. Treatment resolved both the syndrome and hyponatremia, leading to full recovery.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Takotsubo syndrome (TTS) is acute, reversible left ventricular dysfunction without coronary obstruction.
- An 85-year-old female patient with a history of transcatheter aortic valve replacement presented with severe hip pain due to failed osteosynthesis.
Observation:
- During pre-operative assessment, severe hyponatremia secondary to inappropriate antidiuretic hormone secretion was identified.
- The patient acutely developed pulmonary edema, with echocardiography revealing TTS features and a functioning prosthetic aortic valve.
Findings:
- The patient received non-invasive mechanical ventilation, fluid restriction, and diuretics.
- Both the severe hyponatremia and Takotsubo cardiomyopathy resolved completely with treatment.
Implications:
- This case highlights the potential for severe hyponatremia to precipitate Takotsubo syndrome.
- Prompt management of electrolyte imbalances and cardiac dysfunction is crucial for favorable outcomes in elderly patients with complex medical histories.
Abstract:
El Síndrome de Takotsubo es una disfunción ventricular aguda reversible en ausencia de obstrucción coronaria. Una mujer de 85 años de edad con antecedentes de reemplazo valvular aórtico transcatéter, ingresó por dos semanas de dolor severo por una cadera desplazada por osteosíntesis fallida. Mientras se programaba para cirugía, se documentó hiponatremia severa secundaria a secreción inapropiada de hormona antidiurética. Súbitamente desarrolló edema agudo pulmonar. El ecocardiograma confirmó una válvula protésica funcional y aquinesia medial y apical de las paredes del ventrículo izquierdo. Recibió tratamiento con ventilación mecánica no invasiva, restricción de líquidos y diuréticos. La hiponatremia y la cardiomiopatía resolvieron.
Abstract:
Takotsubo syndrome is a form of acute reversible left ventricular dysfunction in the absence of coronary obstruction. An 85-year-old lady with a medical history of transcatheter aortic valve replacement was readmitted complaining of 2 weeks of severe pain by a displaced hip and failed osteosynthesis. While she was scheduled for hip surgery, severe hyponatremia secondary to inappropriate antidiuretic hormone secretion was documented, and sudden-onset pulmonary edema ensued. Echocardiography confirmed normally functioning aortic prosthetic valve and classical features of Takotsubo. She was treated with non-invasive mechanical ventilation, water restriction, and diuretics. Hyponatremia and the cardiomyopathy resolved and the patient recovered completely.
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