Complete Heart Block: A Rare Complication of Takotsubo Syndrome

Takotsubo Syndrome and Complete Heart Block: A Diagnostic and Management Conundrum

There is increasing evidence that Takotsubo cardiomyopathy behaves more like a highly variable and dangerous syndrome than an isolated cardiomyopathy. In this case report, we describe a case of Takotsubo cardiomyopathy complicated by complete heart block. We discuss the potential mechanisms for its etiology and examine the need for pacemaker placement.

Complete AV Block in Vaccinated COVID-19 Patient

Background. Coronavirus 2019 (COVID-19) was initially identified approximately in December 2019 at Wuhan, China, as patients presented with vague prodromal and respiratory symptoms. With the developing investigation of its clinical manifestation, cardiac symptoms have been widely reported including acute coronary syndromes, myocarditis, arrhythmias, heart failure, and cardiac arrest. Case Summary. An 84 year-old male with history of coronary artery disease, hypertension, and hyperlipidemia presented to an outside urgent care with prodromal symptoms. The patient had received the second Pfizer vaccine three months prior. This presentation, he was found to be COVID-19 positive as well as bradycardic with a complete AV block. He was transferred to a tertiary center for further evaluation and management. However, after transfer, the patient refused further invasive cardiac interventions and after medical therapy was discharged home in complete AV block. Discussion. We report a novel case of a Pfizer-vaccinated patient whose initial presenting symptoms of COVID-19 included a complete AV block as well as the challenges and difficulties in approaching such patients. Although this patient’s etiology of his complete AV block may result from multiple factors, given the acuity in setting of concurrent COVID-19 infections, top differentials include viral myocarditis, COVID-19-induced Takotsubo cardiomyopathy complicated by a complete AV-block, or a direct conduction pathway infection. Management of patients should focus on a multidisciplinary approach, and prevention is critical via vaccination.

Meta-analysis of Incidence and outcomes of life-threatening arrhythmias in Takotsubo Cardiomyopathy

Background

Takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy is a transient heart condition that clinically resembles an acute coronary syndrome. This study aims to assess the incidence of life-threatening arrhythmias in patients with Takotsubo cardiomyopathy and evaluate the outcomes of patients with life-threatening arrhythmias (LTAs) in Takotsubo cardiomyopathy compared with those without LTA.

Methods

We comprehensively searched the PubMed, Google Scholar, and Embase databases from inception to February 2021. The primary aim of the study was to determine the incidence of LTAs in TC patients. Other outcomes of interest were the odds of in-hospital, long-term mortality, and cardiogenic shock (CS) in TC patients with LTAs versus those without LTAs. For all statistical analyses, ReviewManager and MedCalc were used.

Results

Eighteen studies were included in this study involving 55,557 participants (2,185 with LTAs and 53,372 without LTAs). The pooled incidence of LTAs in the patients of TC was found to be 6.29% (CI: 4.70–8.08%; I2 = 94.67%). There was a statistically significant increased risk of in-hospital mortality (OR = 4.74; CI: 2.24–10.04; I2 = 77%, p < 0.0001) and cardiogenic shock (OR = 5.60; CI: 3.51–8.95; I2 = 0%, p < 0.00001) in the LTA group versus the non-LTA group. LTA was not associated with long-term mortality (OR = 2.23; CI: 0.94–5.28; I2 = 53%, p = 0.07).

Conclusion

The pooled incidence of life-threatening arrhythmias in the patients of TC was found to be 6.29%. In the group of TC patients with LTAs, the odds of in-hospital mortality and CS, was higher than in the TC patients without LTAs.

Complete Heart Block Complicating Takotsubo Syndrome: Case Report and Literature Review

An 81-year-old woman presents with shortness of breath resulting in a diagnosis of picornavirus and complete heart block. Troponin was elevated and there was concern about acute coronary syndrome. The final diagnosis after echocardiogram and coronary angiogram was Takotsubo syndrome in addition to the heart block which required pacemaker insertion.