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. 2020 Jan 21;21:e920461.
doi: 10.12659/AJCR.920461.

Rare Association of Takotsubo Cardiomyopathy With Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness

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Free PMC article

Rare Association of Takotsubo Cardiomyopathy With Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness

Tikal Kansara et al. Am J Case Rep. .
Free PMC article

Abstract

BACKGROUND Takotsubo cardiomyopathy is characterized by a transient left ventricular dysfunction without obstructive coronary artery disease that mimics an acute myocardial infarction. The electrocardiogram findings of Takotsubo cardiomyopathy usually present with ST-segment elevation or depression, T-wave inversion, left bundle branch block or high-grade atrioventricular block. CASE REPORT This is a report of a case of a 58-year-old male diagnosed with Takotsubo cardiomyopathy that occurred in the setting of an acute asthma exacerbation and psychiatric exacerbation with novel electrocardiogram findings of right bundle branch block. Transthoracic echocardiogram showed a preserved ejection fraction with left ventricular apical ballooning and hyperkinesis of the basal segments. The nuclear stress test showed a fixed perfusion defect at the apical segment, but the patient refused further testing such as coronary angiography. The patient was managed medically, and a repeat echocardiogram done after 8 weeks from discharge showed a complete resolution of the apical ballooning. CONCLUSIONS It is important to recognize that patients with psychiatric illness and asthma exacerbation are predisposed to develop Takotsubo cardiomyopathy. It is also reasonable to suspect Takotsubo cardiomyopathy in the presence of new electrocardiogram findings aside from those typically seen in acute myocardial infarction, especially if it is associated with apical ballooning.

Conflict of interest statement

Conflict of interest: None declared

Conflicts of interest

None.

Figures

Figure 1.
Figure 1.
Electrocardiogram on admission showing new onset right bundle branch block and left posterior fascicular block, rate 80 bpm, PR 146 ms, QTc 447 ms (October 6, 2018 12: 30 PM).
Figure 2.
Figure 2.
Previous electrocardiogram showing normal sinus rhythm, rate of 81 bpm, PR interval 150 ms, QTc 420 ms (July 2017).
Figure 3.
Figure 3.
Electrocardiogram showing new T wave inversions in the anterolateral leads when the troponins peaked at 3.9 ng/mL during the acute episode of agitation and asthma exacerbation. (Oct 7, 2018 2 PM).
Figure 4.
Figure 4.
Initial echocardiogram showing apical ballooning during diastole (A) and systole (B) in the 4-chamber view. Repeat echocardiogram 8 weeks after discharge showing resolution of the apical ballooning during diastole (C) and systole (D) in the 4-chamber view.
Figure 5.
Figure 5.
The nuclear stress test using 99mcTC sestamibi scan showing the fixed perfusion defect on the apical segment.

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