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Takotsubo cardiomyopathy-like phenotype in a boy

Article type: Other

Authors: Firdouse, Mohammed | Garwal, Arnav | Almeida, Claudia Lace De | Mondal, Tapas;

Affiliations: Faculty of Health Sciences, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada | Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada

Note: [] Corresponding author: Dr. Tapas Mondal Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K, Canada. Tel.: +1 905 521 2100 x75259; Fax: +1 905 521 7914; E-mail: [email protected].

Keywords: Takotsubo cardiomyopathy, broken heart syndrome, transient left apical ballooning, stress cardiomyopathy, myocardial stunning

DOI: 10.3233/PIC-13067

Journal: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 187-192, 2013

Received 27 August 2013
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Revision received 31 October 2013
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Accepted 6 November 2013
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Published: 2013
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Abstract

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.