EC Cardiology

A 33 years old female patient presented with shortness of breath of one month duration of acute onset and progressive course, patient had previous history of recurrent supra-ventricular tachycardia. Patient was generally ill with ECG revealed supra-ventricular tachycardia and concomitant severe chest infection. Patient was cardioverted successfully to sinus rhythm with no other abnormalities in the ECG and chest infection resolved after few days. Echocardiogram revealed picture suggestive of dilated cardiomyopathy with estimated ejection fraction 35%, global hypokinesia and severe mitral regurgitation. After one month follow up echocardiogram was normal and patient was generally well. Four months later patient presented to our hospital with shortness of breath again but without supra-ventricular tachycardia nor chest infection, echocardiogram revealed the first picture of dilated cardiomyopathy. Laboratory results showed elevated levels of catecholamines and mild elevation of cardiac enzymes. Patient refused medical treatment and after other month of follow up, echocardiogram was normal.

Conclusion: This case was an atypical presentation of recurrent broken heart syndrome with early differential diagnosis; myocarditis and tachycardia induced cardiomyopathy.

Keywords: Myocarditis; Tachycardia; Cardiomyopathy; Shortness of Breath

1. Marilyn Weigner MD and James P Morgan MD. “Reversible causes of dilated cardiomyopathy” (2000).
2. Bybee KA., et al. “Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction”. Annals of Internal Medicine 11 (2004): 858-865.
3. Traullé S., et al. “[Transient left ventricular apical ballooning or tako-tsubo syndrome: 14 cases]”. La Presse Médicale 11 (2008): 1547-1554.
4. Ilan S Wittstein., et al. “Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress”. John Hopkins Medicine 6 (2005): 539-548.
5. Blessing E., et al. “Recurrence of takotsubo cardiomyopathy with variant forms of left ventricular dysfunction”. Journal of the American Society of Echocardiography 4 (2007): 439.e11-439.e12.
6. Kurowski V., et al. “Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis”. Chest3 (2007): 809-816.
7. Yoshihiro J Akashi., et al. “Takotsubo Cardiomyopathy; A New Form of Acute, Reversible Heart Failure”. Circulation25 (2008): 2754-2762.
8. Parodi G., et al. “Left ventricular apical ballooning syndrome as a novel cause of acute mitral regurgitation”. Journal of the American College of Cardiology 7 (2007): 647-649.
9. Dariush Hghi., et al. “Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy”. Clinical Research in Cardiology 2 (2010): 93-98.