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Distal Limb Ischaemia in Association With Takotsubo Cardiomyopathy
Keng Han Yeap1, Charles Badu-Boateng2, Mark Lloyd3
1Cardiology, London North West University Healthcare National Health Service (NHS) Trust, London, GBR.
Cureus
|September 11, 2023
Summary
Raynaud's phenomenon can lead to severe lower limb ischemia. A case study suggests a link between this condition, Takotsubo cardiomyopathy, and catecholamine surges.
Area of Science:
- Cardiology
- Vascular Medicine
- Endocrinology
Background:
- Raynaud's phenomenon (RP) is a vascular disorder causing digital ischemia.
- RP is often triggered by cold or stress, leading to vasospasm.
- Understanding RP's systemic implications is crucial for patient management.
Observation:
- A 73-year-old female with a history of RP presented with severe bilateral lower limb ischemia.
- Despite no chest pain, ECG showed ST-segment elevation, and troponin levels were markedly elevated, suggesting myocardial injury.
- Echocardiography revealed Takotsubo cardiomyopathy, a stress-induced cardiac dysfunction.
Findings:
- The patient's condition progressed to toe necrosis and auto-amputation over six months despite iloprost treatment.
- Coronary angiography was normal, ruling out obstructive coronary artery disease.
- A significant surge in serum catecholamines is hypothesized to link Raynaud's phenomenon, Takotsubo cardiomyopathy, and severe ischemia.
Implications:
- This case highlights a potential catecholamine-mediated pathway connecting RP and stress-induced cardiomyopathy.
- Further research is needed to elucidate the pathophysiology and develop targeted therapies.
- Recognizing this association may improve diagnostic and therapeutic strategies for patients with severe RP.
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