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Case Report
A rare case of chronic obstructive pulmonary disease induced Takotsubo cardiomyopathy in a male
1 Medical City Fort Worth, Department of Cardiology, 900 8th Ave, Fort Worth, Texas, United States
2 New York Medical College/Saint Michael’s Medical Center Department of Internal Medicine, 111 Centr, United States
3 St. Joseph’s Regional Medical Center, Department of Cardiology, 703 Main Street, Paterson, New Jersey
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Ahsan Khan
New York Medical College/Saint Michael’s Medical Center Department of Internal Medicine, 111 Central Ave, Newark, NJ 07102, 900 8th Ave Fort Worth Texas 76104,
United States
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Article ID: 100980Z01AK2018
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Khan A, Patel B, Qaqa F, Patel P, Shamoon F. A rare case of chronic obstructive pulmonary disease induced Takotsubo cardiomyopathy in a male. Int J Case Rep Images 2018;9:100980Z01AK2018.ABSTRACT
Introduction: Takotsubo cardiomyopathy (TC) is a transient nonischemic cardiomyopathy causing wall motion abnormalities of a particular region of the heart, most commonly the apex. The classic presentation is of a postmenopausal female presenting with chest pain and congestive heart failure in response to an emotional stressor, but physical stressors may cause it as well. Uncommonly, men may present with this condition. We present a rare case of TC in a male, triggered by a COPD exacerbation.
Case Report: A 62-year-old African American Male with a past medical history of COPD presented with shortness of breath, wheezing and chest tightness. The patient had increased his use of his albuterol inhaler to four times a day, which did not relieve his symptoms. His electrocardiogram showed right bundle branch block and nonspecific T wave changes and his troponins progressively increased to 2.47 ng/mL within 6 hours. Echocardiogram showed apical akinesis with a newly reduced ejection fraction of 30–35% Cardiac catheterization revealed nonobstructive coronary artery disease and apical ballooning consistent with Takotsubo cardiomyopathy. Since no other emotional or physical stressor such as sepsis could be identified, it was determined that the patient’s COPD was the trigger. The patient was treated medically for his COPD exacerbation until his symptoms resolved.
Conclusion: This case illustrates the need for a wide differential diagnosis in patient presenting with signs of COPD exacerbation and elevated troponins. COPD causing Takotsubo cardiomyopathy is rare, but not surprising. Evidence is showing that TC is likely caused by increased catecholamine and adrenergic stimulation. COPD exacerbations upregulate the sympathetic nervous system, but the use of beta-2 agonists and anticholinergics as treatment may potentiate TC further based on their mechanisms of action. TC in males is a rare occurrence and it is important to consider that males present with TC differently. They present with more physical rather than emotional precipitators, like our patient and with higher incidence of cardiogenic shock and out-ofhospital cardiac arrest. While the cause of TC is slowly being elucidated, the reason for higher prevalence in females is still unclear.
Keywords: Chronic obstructive pulmonary disease, Male, Stress cardiomyopathy, Takotsubo cardiomyopathy
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Author Contributions
Ahsan Khan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Biren Patel - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Firas Qaqa - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Parthiv Patel - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fayez Shamoon - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Ahsan Khan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
