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Tako-tsubo cardiomyopathy in a male patient after administration of isoproterenol and implantation of a pacemaker

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Author(s): Nidhal Ben Moussa | Mohamed Sami Mourali | Rachid Mechmeche | Ghassen Cherif | Fathia Mghaieth Zghal | Ramy Trabelsi | Sihem Mbarki

Journal: Advances in Molecular Imaging
ISSN 2161-6728

Volume: 02;
Issue: 01;
Start page: 38;
Date: 2011;
Original page

Keywords: Tako-Tsubo Syndrome | Isoprenaline | Pacemaker | Left Ventricular Dysfunction | Ventricular Dysfunction

ABSTRACT
Background: Tako-tsubo cardiomyopathy occurs ty- picallly after an intrinsic adrenergic hyperstimulation triggered by a psychological or physically stressful e- vent. Exceptionally, it may be caused by an exogenous hyperadrenergism. We report the case of an 85 year old man, hypertensive, with a history of ischemic stro- ke. He consulted for signs of heart failure with recur-rent dizziness two weeks which was explained by an atrioventricular block. Initial echocardiography sho- wed left ventricular ejection fraction to 60% with no wall motion abnormalities. The patient received iso-prenaline (0.02 mcg/kg/mn) for 20 hours before the implantation of a single chamber pacemaker. At 24 hours of admission an acute pulmonary edema occu- rred. The control echocardiography showed impaired left ventricular ejection fraction of 25% with apical ballooning and akinesis was also found on ventricu-lography. Coronary angiography showed no signifi-cant coronary lesions. Troponin level was elevated to 2 ng/ml. The pulmonary edema was then controlled. Subsequent clinical and echocardiographic were favo- rable after two weeks which was consistent with the diagnosis of tako-tsubo cardiomyopathy. Conclusion: This case illustrates an example of tako-tsubo syn-drome induced by an exogenous catecholergic stimulation (isoprenaline) combined with an endogenous release after a pacemaker implantation which confirmed the physiopathological hypothesis of a catecholamine- mediated stunning in tako-tsubo cardiomyopathy.
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