Takotsubo syndrome or apical ballooning syndrome is an acute dysfunction of the left ventricle apex related to stressful events. The coronary angiography is negative, the electrocardiogram suggestive of myocardial infarction, constant increase of cardiac enzymes. The prognosis is good, no need prophylactic therapy. Rarely described his association with seizures. We describe the case of a male patient 73 years old, who reported, following a domestic incident, a severe head injury (acute left subdural hematoma, surgically evacuated). In ambulance, episode of ventricular fibrillation with cardiac arrest, with rapid recovery after defibrillation. Encountered in the emergency room increased cardiac enzymes and ECG abnormalities consistent with anterior myocardial infarction, but coronary angiography and echocardiography negative. After six months of the trauma, appearance of attacks compatible with complex partial seizures of right temporomesial onset; incomplete control with carbamazepine. During a further seizure he perceives and reports chest pain. In emergency department: ST elevation in anterior leads, and moderate increase in cardiac enzymes. A myocardial infarct was suspected, but coronary angiography and echocardiography were negative. The two events are therefore compatible with cardiac apical ballooning syndrome, the second induced by epileptic seizure. The takotsubo syndrome, rare cardiac complications of seizures, may be a mechanism underlying some cases of sudden unexpected death in epilepsy (SUDEP).
Takotsubo cardiomyopathy induced by epileptic seizures: a case report.
BENNA, Paolo;
2010-01-01
Abstract
Takotsubo syndrome or apical ballooning syndrome is an acute dysfunction of the left ventricle apex related to stressful events. The coronary angiography is negative, the electrocardiogram suggestive of myocardial infarction, constant increase of cardiac enzymes. The prognosis is good, no need prophylactic therapy. Rarely described his association with seizures. We describe the case of a male patient 73 years old, who reported, following a domestic incident, a severe head injury (acute left subdural hematoma, surgically evacuated). In ambulance, episode of ventricular fibrillation with cardiac arrest, with rapid recovery after defibrillation. Encountered in the emergency room increased cardiac enzymes and ECG abnormalities consistent with anterior myocardial infarction, but coronary angiography and echocardiography negative. After six months of the trauma, appearance of attacks compatible with complex partial seizures of right temporomesial onset; incomplete control with carbamazepine. During a further seizure he perceives and reports chest pain. In emergency department: ST elevation in anterior leads, and moderate increase in cardiac enzymes. A myocardial infarct was suspected, but coronary angiography and echocardiography were negative. The two events are therefore compatible with cardiac apical ballooning syndrome, the second induced by epileptic seizure. The takotsubo syndrome, rare cardiac complications of seizures, may be a mechanism underlying some cases of sudden unexpected death in epilepsy (SUDEP).
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