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Stress-induced cardiomyopathy after exposure to wildfire

Session Poster Session 4

Speaker Vasiliki Kakiouzi

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Clinical
  • Session type : Poster Session

Authors : V Kakiouzi (Athens,GR), A Kitsiou (Athens,GR), D Mytas (Athens,GR), P Grammata (Athens,GR), V Tzeltzes (Athens,GR), T Papafanis (Athens,GR)

Authors:
V Kakiouzi1 , A Kitsiou1 , D Mytas1 , P Grammata1 , V Tzeltzes1 , T Papafanis1 , 1Sismanoglio Hospital - Athens - Greece ,

Citation:

Introduction: It has been described that intense psychological stress may result in myocardial damage and left ventricular dysfunction, known as Takotsubo cardiomyopathy.

Case presentation: An 80-year-old woman presented to the Emergency Department of our hospital due to chest pain after exposure to the wildfire in Mati, Attica, on July 23rd 2018. In addition to smoke inhalation, she had stayed in the sea for about 4 hours before she was eventually rescued.

The patient had a history of arterial hypertension and dyslipidemia (on irbesartan and atorvastatin). The physical examination did not show any abnormal findings from the heart or other organs. Blood pressure was 128/69 mmHg and heart rate was 75 bpm. The electrocardiogram showed sinus rhythm, RBBB (preexisting), ST segment elevation =1 mm and negative T waves in leads I and aVL. Laboratory tests showed an increase in cardiac troponin I (maximum value = 7.161 ng / ml, with a normal reference value of <0.04 ng / ml). Thansthoracic echocardiogram showed a significant reduction in left ventricular (LV) systolic function (EF˜ 35%) with severe hypokinesis of the apex, apical-mid anterior wall and apical-mid-anterior intraventricular septum. The patient underwent coronary angiography which revealed normal coronary arteries. She was discharged on medical therapy (irbesartan, metoprolol, eplerenone, atorvastatin and acetylsalicylic acid).

Conclusion-outcome: The patient remained asymptomatic. Transthoracic echocardiogram, performed one month after her discharge from the hospital, showed normal LV systolic function without regional wall motion abnormalities. It is concluded that this represents a case of cardiomyopathy caused by intense psychological stress, due to exposure to a natural disaster.

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