Takotsubo Cardiomyopathy in the Setting of Hypertrophic Cardiomyopathy Following Pacemaker Implantation

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Cardiac Electrophysiology

Background:

• Takotsubo cardiomyopathy (TC) shares clinical and echocardiographic features with acute coronary syndrome (ACS).
• TC is often triggered by emotional or physical stress and is linked to various comorbidities.
• Hypertrophic cardiomyopathy (HCM) is associated with heightened cardiac sympathetic activity.

Observation:

• A 73-year-old female with known hypertrophic obstructive cardiomyopathy (HOCM) presented with high-degree atrioventricular (AV) block.
• The patient required permanent pacemaker (PPM) implantation for the AV block.
• Following PPM placement, the patient developed Takotsubo cardiomyopathy (TC).

Findings:

• This case illustrates a multifactorial presentation of TC in a patient with underlying HOCM.
• The study suggests a potential increased susceptibility to TC in HOCM patients during procedures like PPM placement.
• The interplay between HOCM, autonomic dysfunction, and iatrogenic stress is implicated.

Implications:

• Recognizing the heightened risk of TC in HOCM patients undergoing cardiac procedures is crucial for early diagnosis and management.
• Further research is warranted to elucidate the mechanisms linking HOCM, autonomic nervous system activity, and TC development.
• This case underscores the importance of considering TC in the differential diagnosis of new-onset cardiac dysfunction in susceptible populations.