Tako-tsubo cardiomyopathy following gastroscopy: a complication to consider

A 69-year-old woman, who was a former smoker, presented with dysphagia to solids and liquids and epigastric pain over a period of 8 weeks. An upper gastrointestinal endoscopy was performed, without incident, and revealed gastric atrophy in the antrum ([Fig. 1]). Biopsies were taken according to the Sydney protocol.

Fig. 1 Gastrointestinal endoscopy revealed gastric atrophy in the antrum.

After the procedure the patient suffered from chest pain. Electrocardiogram revealed T-wave inversion in precordial leads DI-AVL and V2-V5 ([Fig. 2]). Troponin level was also elevated (0.53 ng/mL). Urgent coronary angiography was performed and revealed entirely normal coronary vasculature. Left ventriculography demonstrated akinesis of the mid-ventricular anterior segment ([Fig. 3], [Video 1]).

Fig. 2 Electrocardiogram: T-wave inversion in leads DI-AVL and V2-V5.

Fig. 3 Ventriculography. a Ventricular diastole. b Ventricular systole. Akinesis in the mid-ventricular anterior segment with contractility preserved in the apical and basal segments of the left ventricle. c Quantitative analysis of the contractility, showing akinesis in the mid-ventricular anterior segment.

Video 1 Tako-tsubo cardiomyopathy following gastroscopy.

Echocardiography showed an ejection fraction of 60 % and confirmed the akinesis of the mid-ventricular anterior segment. The patient’s symptoms improved with aspirin and a beta blocker. There were no complications and the patient was discharged after 72 hours, without any symptoms.

A diagnosis of tako-tsubo cardiomyopathy (TTC) following gastroscopy was made based on the transient and completely reversible wall motion abnormalities and chest pain syndrome without occlusive coronary disease. TTC is a reversible cardiomyopathy that typically occurs in women over the age of 50 years and can mimic an acute coronary syndrome [1]. There are few reports of TTC after gastrointestinal procedures (oral-contrast radiology and colonoscopy) [2]. It has been suggested that catecholamines may play a role in triggering TTC because patients often have preceding emotional or physical stress [3]. Overall the long-term survival is the same as that of the age-matched population and recurrence is possible [4].

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• References

• 1 Patel A, Namn Y, Shah S. et al. Takotsubo cardiomyopathy after an upper and lower endoscopy: a case report and review of the literature. J Med Case Rep 2019; 13: 81
• 2 Mohammad M, Patel A, Koirala A. et al. Tako-tsubo cardiomyopathy following colonoscopy: insights on pathogenesis. Int J Cardiol 2011; 147: e46-e49
• 3 Kurisu S, Kihara Y. Tako-tsubo cardiomyopathy: clinical presentation and underlying mechanism. J Cardiol 2012; 60: 429-437
• 4 Kazakauskaité K, Jankauskas A, Lapinskas T. et al. Tako tsubo cardiomyopathy: the challenging diagnosis in clinical routine. Medicina (Kaunas) 2014; 50: 1-7