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Takotsubo cardiomyopathy-like phenotype in a boy


Takotsubo cardiomyopathy is characterized by the acute onset of a reversible left ventricular wall motion abnormality that extends beyond a single coronary artery’s distribution, following a period of emotional or physical stress. We present a 4 yr 11 mo old boy who was admitted to the pediatric intensive care unit a few days following tonsillectomy and adenoidectomy. The patient presented with mild cyanosis, shortness of breath and decreased levels of consciousness. Initial investigations revealed significant hypokinesia and dilatation of the mid and apical segments of the left ventricle along with preserved function of the basal segment. The patient was given inotropes and diuretics for hemodynamic management. The patient made a complete recovery with normalization of cardiac function within 3-4 wk. Upon follow up, the patient had normal sinus rhythm, improved ejection fraction and no ventricular wall motion abnormalities. The authors believe the myocarditis, rhabdomyolysis, and sepsis following tonsillectomy and adenoidectomy to be the stressors in this case. The rarity of cases that phenotypically mimic classical Takotsubo cardiomyopathy in children makes this case of special interest to pediatricians and cardiologists.