Endobronchial intubation for a lung biopsy in a 67-year-old female with a neuroendocrine tumor triggered Takotsubo cardiomyopathy, with LVEF recovering from 35-40% to 53% after 2 days.
Case Report (n=1)
Highlights the risk of Takotsubo cardiomyopathy triggered by intubation and hypoxia during pulmonary procedures, particularly in patients with neuroendocrine tumors.
Abstract Background Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, is a reversible acute cardiac dysfunction of the left ventricle related to transient regional wall motion abnormalities. It is precipitated by physical or emotional stress. It resembles acute coronary syndrome (ACS) however it shows normal coronary arteries on angiography. Case Presentation A 67 old non- smoker female with history of hypertension, IBS, fibromyalgia was referred for CT-guided percutaneous biopsy of a 2 cm left lower lobe pulmonary nodule. Baseline ECG and Echo were normal. The procedure required intubation, during intubation she had ST segment elevations in leads I and aVL with reciprocal changes. The procedure was aborted, and she underwent cardiac catherization. The results reveled normal coronaries, significant elevated left ventricular end diastolic pressure with left ventricular gram reveling apical ballooning with basal sparing suggestive of Takotsubo cardiomyopathy. High-sensitivity troponin I peaked at 1.202 ng/L. Transthoracic echocardiogram demonstrated apical ballooning with preserved basal segment contractility and an estimated left ventricular ejection fraction (LVEF) of 35-40% consistent with TCM. She was treated with supportive therapy, started on spironolactone, dapagliflozin and ACE inhibitors. Beta blockers were avoided as her mean arterial pressure was low. Repeat echocardiogram after 2 days showed normalization of LVEF (53%) and resolution of wall motion abnormalities. The final pathology from the biopsy confirmed carcinoid tumor of the lung. Discussion TCM is an acute stress-induced cardiomyopathy, it’s a reversible dysfunction of the left ventricle. It is uncommon but clinically significant and can mimic ACS.It is typically characterized by ballooning of the left ventricular wall with out no coronary vessel obstruction. Due to stress, it can be induced from procedures including bronchoscopy, endoscopy, and anesthesia induction. In our case a transient hypoxia may have precipitated the sympathetic surge leading to myocardial stunning. Recognization during procedures is critical, due to similar prevention of myocardial infarction however, its management is different as it only requires support care with treatment of complications and avoidance of trigger. This case highlights the need to be watchful during pulmonary procedures, particularly in patients who might be at a higher risk, like our patient who had neuroendocrine tumor which puts her at a higher risk factor. Conclusion Takotsubo cardiomyopathy should be considered in patients with suspected lung cancer undergoing any procedure, with a possibility of having a neuroendocrine tumor and stress exacerbation of catecholamine surge leading to its development. Early recognition with supportive care prompts cure. This abstract is funded by: None
S G Tigabe (Fri,) conducted a case report in Takotsubo cardiomyopathy (n=1). Endobronchial intubation for CT-guided lung biopsy was evaluated. Endobronchial intubation for a lung biopsy in a 67-year-old female with a neuroendocrine tumor triggered Takotsubo cardiomyopathy, with LVEF recovering from 35-40% to 53% after 2 days.