Seizure‐Induced Cardiomyopathy

1Trinitas Regional Medical center, Seton Hall university Medical Sciences, Elizabeth, NJ
2Cleveland Clinic, Cleveland, OH
3Cleveland Clinic, Cleveland, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 305

Case Presentation:

A 54‐year‐old previously healthy woman was admitted to our hospital for new‐onset seizure. Patient was sitting in the ready area with her flight crew, felt lightheaded, when she suddenly found herself on the floor where she had a witnessed generalized tonic–clonic seizure for 4 minutes followedby postictal confusion, which lasted for 10 minutes. There was no history of urinary or bowel incontinence, weakness, dysarthria, or facial droop. Surgical history was significant for tummy tuck surgery. On presentation, vital signs were stable. She was conscious and alert with no focal neurological deficits. The rest of her systemic examination was unremarkable. Initial labs showed troponin T levels were positive at 0.97. Urine drug screen was negative. EKG showed ST depression in leads II, III, aVF, V3, V4, V5, and V6, suggestive of non‐ST‐segment‐elevation myocardial infarction. CT of the brain showed no acute intracranial hemorrhage. MRI showed some chronic microvascular ischemic changes. Repeat EKG showed T‐wave inversions in leads I, aVL, V7, and V8, typical evolutionary changes of NSTEMI. 2‐D echocardiogram showed ejection fraction of 55%–60%. Normal left ventricular size with normal systolic and diastolic function. Cardiac catheterization with left ventriculogram showed Takotsubo cardiomyopathy with anterolateral marked hypokinesia and patent coronaries. Patient was treated with aspirin, metoprolol, and atorvastatin.

Discussion:

Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction; typically with apical akinesis. The most common clinical presentation is chest pain and dyspnea associated with electrocardiographic changes of ST‐segment elevation or T‐wave inversion, which mimics acute myocardial infarction in patients with clean coronaries on coronary angiography. The syndrome is characterized by transient ventricular wall‐motion abnormalities of the ventricular apex and midventricle in the absence of obstructive epicardial disease. This case is peculiar, as the presentation is seizure in a patient with no significant cardiac history or risk factors, presented as NSTEMI. Furthermore, the cardiac catheterization showed anterolateral hypokinesis instead of apical hypokinesis. At present, the cause of this syndrome remains unknown. An episode of emotional or physiologic stress frequently precedes presentation with this syndrome. Overall, the in‐hospital mortality rate for Takotsubo cardiomyopathy remains very low, as does the risk for recurrence.

Conclusions:

This case illustrates the importance of physicians recognizing the unusual association of Takotsubo cardiomyopathy and seizure. To the best of our knowledge, the seizure‐induced cardiomyopathy in our case has never been reported in the previous literature.

To cite this abstract:

Nidimusili A, Alraies M, Shaheen K. Seizure‐Induced Cardiomyopathy. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 305. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/seizureinduced-cardiomyopathy/. Accessed July 21, 2019.

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