Heart broken by a mosquito; an unusual case of Takotsubo cardiomyopathy (RCD code: III‐5B)
Pakistan has recently witnessed an epidemic of dengue infection and thereafter, certain various presentations of patients with dengue infection have been reported. The cardiac manifestation of dengue infection is primarily an inflammatory response to infection, however, dengue can rarely present as Takotsubo syndrome. Here, we report a the case of a 69‐year- old male, who presented with fever and ab‐
dominal pain and was diagnosed with dengue fever on serological workup. Just prior to being discharged, the patient developed acute chest pain, and dyspnoea with ST‐segment elevation in the anterolateral leads on electrocardiogram and raised cardiac biomarkers. An urgent coronary angiogram showed non‐obstructive coronary artery disease with apical ballooning on ventriculography. On the basis of this, the patient was diagnosed as have TTS associated with dengue fever. The patient was medically treated with success and was later discharged. He remains currently asymptomatic and his left ventricular ejection fraction recovered to normal (60%) on repeat echo after 6 months. JRCD 2018; 3 (8): 278–280
Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006; 27(13):1523–1529.
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373(10): 929–938.
Sharkey SW, Maron BJ. Epidemiology and clinical profile of Takotsubo cardiomyopathy. Circulation 2014; 78(9): 2119–2128.
Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol 2008; 124(3):283–292.
Akashi YJ, Goldstein DS, Barbaro G, et al. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 2008;118(25): 2754–2762.
De Giorgi A, Fabbian F, Pala M, et al. Takotsubo cardiomyopathy and acute infectious diseases: a mini‐review of case reports. Angiology 2015; 66(3):257–261.
Badve SV, Patil S, Rathod NM, et al. Dengue fever and takotsubo cardiomyopathy. J Assoc Physicians India 2015; 63(7): 67–70.
Chou MT, Yu WL. Takotsubo cardiomyopathy in a patient with dengue fever. J Formos Med Assoc 2016; 115(9): 818–819.
Lyon AR, Rees PS, Prasad S, et al. Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine‐induced acute myocardial stunning. Nat Rev Cardiol 2008; 5(1): 22.
Wittstein IS, Thiemann DR, Lima JA, et al Neurohumoral features of myocardial
stunning due to sudden emotional stress. N Engl J Med 2005; 352(6): 539–548.
Miranda CH, Borges MD, Matsuno AK, et al. Evaluation of cardiac involvement during dengue viral infection. Clin Infect Dis 2013; 57(6): 812–819.
Salgado DM, Panqueba CA, Castro D, et al. Myocarditis in children affected by dengue hemorrhagic fever in a teaching hospital in Colombia. Revista de Salud Pública 2009; 11(4): 591–600.
Wali JP, Biswas A, Chandra S, et al. Cardiac involvement in dengue haemor-rhagic fever. Int J Cardiol 1998; 64(1): 31–36.
Ghadri JR, Wittstein IS, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J 2018; 39(22): 2032–2046.
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