Author + information
- Siddharth Shah,
- Kalyan Wagle,
- Suhayb Kadura and
- Daniel Villarreal
Stress cardiomyopathy is a reversible entity and has favorable prognosis in most cases. However, fatal complications can occur in acute phase affecting mortality.
A 66-year old female presented with angina. ECG revealed ST segment elevation in the anterolateral leads and QTc of 510 ms. Cardiac catheterization revealed insignificant CAD. Echocardiogram showed LVEF of 35%-40% and apical akinesia. Her diagnosis was consistent with stress cardiomyopathy. She required inpatient treatment with diuretics for CHF and was discharged on metoprolol, lisinopril and furosemide. QTc was 480 ms at discharge. One week later, she was found unresponsive. On EMS arrival, she was found to have pulseless ventricular tachycardia with restoration of sinus rhythm following defibrillation. ECG revealed diffuse broad T wave inversion and QTc of 672. Identifiable reversible triggers for QT prolongation were serum K+ of 3.4 mmol/L which was corrected and home medications including trazodone, fluoxetine and bupropion which were discontinued. She had recurrent episodes of torsades de pointes requiring defibrillation during hospitalization.
Knowledge regarding ECG changes in stress cardiomyopathy and its prognostic significance is limited. Ventricular arrhythmias are rare occurring in 4%-9% of cases. Significant QTc variation was noted in our case with normal QTc at times and severe prolongation on other occasions, even after correction of all reversible factors. It's pathophysiology and optimal management remains clear. Our patient was treated with mexiletine and dopamine, high doses of magnesium and metoprolol were discontinued. The benefit of lifevest in patients with VT and cardiac arrest until the QTc and LVEF improves and the role of ICD in patients where LVEF and QTc fails to improve requires further study.
Our case highlights that dynamic changes in QT interval can happen in stress cardiomyopathy. Avoiding dyselectrolytemia and QTc prolonging drugs in stress cardiomyopathy is of utmost importance. The benefit of lifevest and ICD in patients with stress cardiomyopathy needs to be explored.
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: FIT Clinical Decision Making: Heart Failure and Cardiomyopathies 3
Abstract Category: Heart Failure and Cardiomyopathies
Presentation Number: 1216-181
- 2019 American College of Cardiology Foundation