lisinopril and Takotsubo-Cardiomyopathy

A woman in her 60s presented initially with nausea, vomiting and abdominal pain. She rapidly progressed to respiratory failure requiring intubation. ECG demonstrated no significant ST segment changes. Troponin I and brain natriuretic peptide were elevated. Chest CT angiography demonstrated small non-occlusive segmental pulmonary emboli. Transthoracic echocardiogram findings suggested biventricular takotsubo cardiomyopathy (TCM) with left ventricular ejection fraction of less than 20%. She improved with aggressive management and was discharged on carvedilol, lisinopril, atorvastatin and apixaban. Follow-up echocardiogram revealed complete resolution of the left and right ventricular wall motion abnormalities at 9 weeks. She had symptoms recurrence after 7 months from the initial presentation. Repeated echocardiogram was consistent with biventricular TCM recurrence. Despite aggressive medical therapy, multiorgan failure developed and patient care was later transitioned to palliative care.

Topics: Atorvastatin; Carvedilol; Fatal Outcome; Female; Humans; Lisinopril; Natriuretic Peptide, Brain; Stroke Volume; Takotsubo Cardiomyopathy; Troponin I; Ventricular Function, Left

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Echocardiography; Female; Humans; Lisinopril; Metoprolol; Middle Aged; Recurrence; Takotsubo Cardiomyopathy; Urinary Tract Infections

BACKGROUND Synthetic cannabinoids have a higher affinity for the cannabinoid receptors CB1 and CB2 than natural cannabinoids. Their use can be associated with cardiovascular disease and neurological complications. A case is reported of status epilepticus and stress cardiomyopathy following the recreational use of the synthetic cannabinoid, UR-144. CASE REPORT A 19-year-old woman presented to the emergency department in status epilepticus after smoking the synthetic cannabinoid known as 'space'. Recurring seizure activity was controlled after three hours. On hospital day 3, the patient developed severe biventricular failure. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of stress cardiomyopathy. A comprehensive urine drug screen was performed using gas chromatography-mass spectrometry (GC-MS), which was positive for UR-144, or (1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)-methanone, and negative for all other illicit recreational drugs. The patient improved at one week following admission, with a left ventricular ejection fraction (LVEF) of 40%. She was discharged home on hospital day 10. CONCLUSIONS The use of the synthetic cannabinoid, UR-144, may be associated with prolonged status epilepticus and stress cardiomyopathy. Physicians should be aware of these potentially lethal complications associated with the recreational use of this and other illicit synthetic cannabinoids.

Topics: Bisoprolol; Cannabinoids; Drug Overdose; Female; Gas Chromatography-Mass Spectrometry; Humans; Indoles; Lisinopril; Smoking; Status Epilepticus; Substance Abuse Detection; Takotsubo Cardiomyopathy; Young Adult

An adult man with long-standing poorly controlled cardiac risk factors presented with acute decompensated heart failure (ADHF). Echocardiogram, cardiac MRI and catheterisation suggested idiopathic dilated cardiomyopathy, severe systolic dysfunction, ejection fraction 25% with global left ventricular (LV) dilation and apical thrombus. He responded well to diuretics and gradual uptitration of lisinopril and carvedilol. Follow-up echocardiogram in 2 months demonstrated complete recovery of systolic function, normalisation of LV size and shape with severe LV hypertrophy. This presentation is potentially a global variant of stress cardiomyopathy with recovery of LV function, highlighting the importance of appropriate imaging, catheterisation and clinical monitoring in patients with ADHF.

Topics: Cardiac Catheterization; Cardiotonic Agents; Coronary Angiography; Diagnosis, Differential; Echocardiography; Humans; Hypertension; Lisinopril; Magnetic Resonance Imaging; Male; Middle Aged; Takotsubo Cardiomyopathy

Pheochromocytoma is a rare catecholamine-secreting tumour that is typically located in the adrenal medulla or along the sympathetic ganglia. The typical symptoms are episodic in nature and include tachycardia, sweating and headache. These tumours can present as transient, reversible cardiomyopathy similar to takotsubo cardiomyopathy (TCM). TCM is characterised by transient hypokinesis of the left ventricular apex and is typically induced by emotional stress. We describe the case of a 26-year-old woman with a medical history significant for headaches who presented initially to her family physician with nausea, vomiting, headache and hypertension. She was started on lisinopril 10 mg daily. One week later, she presented to the emergency department with substernal severe chest pressure. Her troponin level was elevated. Coronary angiogram showed normal coronary arteries and left ventriculogram showed inverse TCM pattern. Serum catecholamines were very elevated confirming pheochromocytoma. She was successfully treated with alpha-blockers followed by surgical resection.

Topics: Adrenal Gland Neoplasms; Adrenergic alpha-Antagonists; Adult; Antihypertensive Agents; Coronary Angiography; Electrocardiography; Female; Headache; Humans; Hypertension; Lisinopril; Nausea; Pheochromocytoma; Takotsubo Cardiomyopathy; Treatment Outcome; Vomiting

Topics: Cardiotonic Agents; Echocardiography; Electrocardiography; Female; Humans; Life Change Events; Lisinopril; Metoprolol; Middle Aged; Sympatholytics; Takotsubo Cardiomyopathy; Treatment Outcome; Troponin

Graves hyperthyroidism is commonly seen in clinical practice and Takotsubo stress cardiomyopathy is an increasingly recognized cardiac complication of physical or emotional stress. We report the rare case of a patient with Graves hyperthyroidism that was complicated by severe biventricular takotsubo cardiomyopathy, which was demonstrated on heart catheterization. After appropriate pharmacologic treatment of her hyperthyroidism, she had complete resolution of her cardiomyopathy.

Topics: Adult; Carbazoles; Carvedilol; Drug Therapy, Combination; Electrocardiography; Female; Graves Disease; Humans; Hyperthyroidism; Lisinopril; Methimazole; Propanolamines; Takotsubo Cardiomyopathy; Thyroid Function Tests; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right