Point-of-Care Ultrasound for the Diagnosis of Takotsubo Cardiomyopathy

Figure

Left: echocardiography, apical four-chamber view RV, right ventricle; RA, right atrium; LV, left ventricle; LA, left atrium; in systole, the LV shows ballooning (red asterisk) of the apical region of the heart with local akinesia. The basal wall segments exhibit good contraction. In terms of image morphology, the left ventricle resembles a Japanese octopus trap (takotsubo). Right: graphic representation of the trend in hs-troponin levels following the days after admission.

A 71-year-old female patient presented to our emergency department with acute dyspnea in exacerbated COPD. Following transfer to a normal ward, laboratory tests revealed a pronounced increase in hs-troponin level (Figure, right) without an electrocardiographic correlate. Because an invasive exclusion of coronary macroangiopathy and an unremarkable echocardiography had been performed three months previously, an immediate cardiac catheterization was waived. Due to progressive dyspnea and newly diagnosed tachycardic atrial fibrillation, the patient was transferred to our intensive care unit (day 2 following admission). Point-of-care ultrasound (POCUS) on takeover showed takotsubo cardiomyopathy with ballooning in the apical region of the heart (Figure, left). This was most likely triggered by severe dyspnea. The patient reported that this had caused her to fear for her life. The patient stabilized with standard therapy comprising beta blockers, ACE inhibitors, therapeutic anticoagulation, and anxiolysis with benzodiazepines and a morphine pump. The rise in troponin declined in the further course, and pump function normalized on standardized echocardiography (day 13 following admission). The case presented here illustrates the relevance of POCUS for the immediate differential diagnosis of acute symptom complexes.

Dr. med. David Janke*, DRK Kliniken Berlin Westend und Mitte, Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin, Berlin, [e-mail]

Dr. med. Benedikt Hübner*, DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Gastroenterologie, Berlin

Dr. med. Ulrike Ketterer, DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Kardiologie, Berlin

*These authors share first authorship.

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Janke D, Hübner B, Ketterer U: Point-of-care ultrasound for the diagnosis of takotsubo cardiomyopathy.
Dtsch Arztebl Int 2022; 119: 894. DOI: 10.3238/arztebl.m2022.0347