Can a pneumothorax break your heart?
Takotsubo cardiomyopathy or apical ballooning is a condition characterized by transitory left ventricular dysfunction, affecting commonly postmenopausal females after foregoing acute emotional or physical stress. We report a case of a 63 year old female presenting with severe dyspnea and right-sided secondary spontaneous pneumothorax, initially treated with tube thoracostomy. Despite the fact that pneumothorax resolved, shortness of breath persisted and due to ST-segment elevation and increased Troponin I levels, she was admitted to cardiac catheterization. A significant coronary stenosis was ruled out and the diagnosis of a Takotsubo cardiomyopathy was established. Electrocardiographic findings were normalized within three days and attributable to prolonged air leakage. A thoracoscopic apex resection followed by a partial parietal pleurectomy was performed. Although Takotsubo cardiomyopathy is a rare syndrome, it should always be considered as a potential cardiac complication of a pneumothorax.
Sousa C, Neves J, Sa N, Goncalves F, Oliveira J, Reis E: 3. Spontaneous pneumothorax: a 5-year experience. J Clin Med Res. 2011;3(3):111-7. http://dx.doi.org/10.4021/jocmr560w
Weissberg D, Rafaely Y. Pneumothorax: experience with 1,999 patients. Chest. 2000;117(5):1279-85. http://dx.doi.org/10.1378/chest.117.5.1279
Kim SJ, Lee HS, Kim HS, Shin HS, Lee JW, Kim K-II, et al. Outcome of video-assisted thoracoscopic surgery for spontaneous secondary pneumothorax. Koren J Thorac Cardiovasc Surg. 2011;44(3);225-8. http://dx.doi.org/10.5090/kjtcs.2011.44.3.225
Mavridis S, Gnauk HG, Schumacher M, Wagner RH. Spontaneous pneumothorax complicating lung emphysema. So, what's the catch?. Med J Indones. 2013;22(1):54-6. http://dx.doi.org/10.13181/mji.v22i1.514
Nef HM, Möllmann H, Elsässer A. Tako tsubo cardiomyopathy (apical ballooning). Heart. 2007;93:1309-15. http://dx.doi.org/10.1136/hrt.2006.101675
Waldenborg M, Soholat M, Kähäri A, Emilsson K, Fröbert O. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study. BMC Cardiovasc Disord. 2011;9:11-4. http://dx.doi.org/10.1186/1471-2261-11-14
Kurisu S, Ishibashi K, Kato Y, Mitsuba N, Dohi Y, Nishioka K, Kihara Y: Tako tsubo cardiomyopathy complicated by QRS prolongation. Intern Med. 2012;51(3):291-4. http://dx.doi.org/10.2169/internalmedicine.51.6292
Chia PL, Foo D. Tako tsubo cardiomyopathy precipitated bei pheochromocytoma crisis. Cardiology Journal. 2011;18(5):564-7. http://dx.doi.org/10.5603/CJ.2011.0015
Steinhäuslin CA, Cuttat JF. 12. Spontaneous pneumothorax. A complication of lung cancer?. Chest. 1985;88(5):709-13. http://dx.doi.org/10.1378/chest.88.5.709
Akashi YJ, Sakakibara M, Miyake F. Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with pneumothorax. Heart. 2002;87(2):e1. http://dx.doi.org/10.1136/heart.87.2.e1
Villablanca PA, Sukhal S, Ansari A, Mohammed D. Acute gastritis-induced Takotsubo's cardiomyopathy. Clinical Case Reports. 2013;1(2):91-5. http://dx.doi.org/10.1002/ccr3.32
Ha JH, Lee H, Park YJ, Kang HH, Lee SH, Moon HS. Takotsubo cardiomyopathy caused by pulmonary tuberculosis: a case report. Tuberc Respir Dis (Seoul). 2014;77(1):24-7. http://dx.doi.org/10.4046/trd.2014.77.1.24
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