Severe Biventricular Takotsubo Syndrome Triggered by Status Epilepticus With Pulmonary Embolism and Critical Illness Myopathy

Takotsubo syndrome is a reversible stress-induced cardiomyopathy that frequently mimics acute coronary syndrome and is precipitated by intense emotional, neurologic, or physiologic stress.

An 81-year-old woman presented with generalized tonic-clonic seizure and subsequently developed nonconvulsive status epilepticus, cardiogenic shock, and severe biventricular systolic dysfunction with a left ventricular ejection fraction of <20%, later recovering to 55% to 60%. Her hospital course was complicated by subsegmental pulmonary embolism, hypoxic respiratory failure, metabolic encephalopathy, and prolonged intensive care unit stay requiring inpatient rehabilitation for critical illness myopathy.

Research describes clear associations between Takotsubo syndrome and seizures, although the true prevalence is unclear. This case illustrates Takotsubo as a consequence of neurologic stress, underscoring the importance of early cardiac evaluation.

Takotsubo syndrome should be considered in patients with status epilepticus who develop hemodynamic deterioration. These patients need serial reassessment during recovery because severe neurologic illness may evolve into a prolonged multisystem critical illness.