Abstract
Introduction
Takotsubo cardiomyopathy can complicate several conditions including neurological emergencies. A few recurrent cases associated with seizures have been reported, but none of the patients had status epilepticus. The pathophysiology of takotsubo syndrome, although debated, may involve stunning of the myocardium by a catecholamine storm triggered by stress. Patients with epilepsy may be at increased risk for takotsubo syndrome, which may occur repeatedly.
Methods
We report on a postmenopausal woman with symptomatic epilepsy who experienced recurrent takotsubo cardiomyopathy triggered by convulsive status epilepticus. Brief seizures were not associated with takotsubo syndrome. The relevant literature was reviewed.
Results
Over a 1-year period, she experienced two episodes of convulsive status epilepticus with complete neurological recovery after treatment. Echocardiography showed latero-septo-apical hypokinesia and apical ballooning. The cardiac abnormalities resolved fully and she recovered her baseline level of self-sufficiency. During the same period, she experienced several brief seizures, with no cardiac manifestations.
Conclusion
The occurrence of takotsubo cardiomyopathy in association with convulsive status epilepticus, but not with brief seizures, supports neurogenically mediated myocardial stunning related to direct toxicity of endogenous catecholamines. Neuro-intensivists must be aware of this potentially fatal but fully reversible cardiac complication, which may be among the causes of death in patients with status epilepticus.
Similar content being viewed by others
References
Lemke DM, Hussain SI, Wolfe TJ, et al. Tako-Tsubo cardiomyopathy associated with seizures. Neurocrit Care. 2008. doi:10.1007/s12028-008-9075-x.
Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol. 1991;21:203–14.
Nef HM, Möllmann H, Elsässer A. Tako-tsubo cardiomyopathy (apical ballooning). Heart. 2007;93:1309–15.
Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002;143:448–55.
Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004;94:343–6.
Kurisu S, Inoue I, Kawagoe T, et al. Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. J Am Coll Cardiol. 2003;41:743–8.
Ito K, Sugihara H, Katoh S, Azuma A, Nakagawa M. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT – comparison with acute coronary syndrome. Ann Nucl Med. 2003;17:115–22.
Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858–65.
Wittstein IS. Apical-ballooning syndrome. Lancet. 2007;370:545–7.
Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–48.
Owa M, Aizawa K, Urasawa N, et al. Emotional stress-induced ‘ampulla cardiomyopathy’: discrepancy between the metabolic and sympathetic innervation imaging performed during the recovery course. Jpn Circ J. 2001;65:349–52.
Mori H, Ishikawa S, Kojima S, et al. Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovasc Res. 1993;27:192–8.
Ueyama T, Hano T, Kasamatsu K, Yamamoto K, Tsuruo Y, Nishio I. Estrogen attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo (Ampulla) cardiomyopathy. J Cardiovasc Pharmacol. 2003;42(Suppl 1):S117–9.
Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24:471–6.
Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia. 1993;34(Suppl 1):S54–8.
Benowitz NL, Simon RP, Copeland JR. Status epilepticus: divergence of sympathetic activity and cardiovascular response. Ann Neurol. 1986;19:197–9.
Meierkord H, Shorvon S, Lightman SL. Plasma concentrations of prolactin, noradrenaline, vasopressin and oxytocin during and after a prolonged epileptic seizure. Acta Neurol Scand. 1994;90:73–7.
Simon RP, Aminoff MJ, Benowitz NL. Changes in plasma catecholamines after tonic-clonic seizures. Neurology. 1984;34:255–7.
Chin PS, Branch KR, Becker KJ. Postictal neurogenic stunned myocardium. Neurology. 2005;64:1977–8.
Shimizu M, Kagawa A, Takano T, Masai H, Miwa Y. Neurogenic stunned myocardium associated with status epileptics and postictal catecholamine surge. Intern Med. 2008;47:269–73.
Bosca ME, Valero C, Pareja AI, et al. Tako-tsubo cardiomyopathy and status epilepticus: a case report. Eur J Neurol. 2008;15:e34–5.
Sakuragi S, Tokunaga N, Okawa K, Kakishita M, Ohe T. A case of takotsubo cardiomyopathy associated with epileptic seizure: reversible left ventricular wall motion abnormality and ST-segment elevation. Heart Vessels. 2007;22:59–63.
Legriel S, Mourvillier B, Bele N, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34:476–80.
Yaoita H, Yamaki T, Mizugami H, et al. A case of recurrent chest pain with reversible left ventricular dysfunction and ST segment elevation on electrocardiogram. Int Heart J. 2005;46:147–52.
Spes C, Knape A, Mudra H. Recurrent tako-tsubo-like left ventricular dysfunction (apical ballooning) in a patient with pheochromocytoma – a case report. Clin Res Cardiol. 2006;95:307–11.
Shimizu M, Kato Y, Masai H, Shima T, Miwa Y. Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: a case report. J Cardiol. 2006;48:101–7.
Nef HM, Mollmann H, Vogt A, et al. Multiple episodes of a transient global left ventricular dysfunction reminiscent to apical ballooning. Cardiology. 2007;108:1–3.
Leung Ki EL, Delabays A, Lyon X, Pruvot E. A case of recurrent transient left ventricular apical ballooning associated with atrial fibrillation. Int J Cardiol. 2007;118:e35–8.
Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart. 2003;89:1027–31.
Blessing E, Steen H, Rosenberg M, Katus H, Frey N. Recurrence of takotsubo cardiomyopathy with variant forms of left ventricular dysfunction. J Am Soc Echocardiogr. 2007;20:439.e11–2.
Azzarelli S, Galassi AR, Amico F, et al. Clinical features of transient left ventricular apical ballooning. Am J Cardiol. 2006;98:1273–6.
Ennezat PV, Pesenti-Rossi D, Aubert JM, et al. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005;22:599–602.
Craig S. Phenytoin poisoning. Neurocrit Care. 2005;3:161–70.
Acknowledgment
We thank A. Wolfe MD for helping to prepare the manuscript. This study received no financial support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Legriel, S., Bruneel, F., Dalle, L. et al. Recurrent Takotsubo Cardiomyopathy Triggered by Convulsive Status Epilepticus. Neurocrit Care 9, 118–121 (2008). https://doi.org/10.1007/s12028-008-9107-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-008-9107-6