Presented at the 2012 AAPM Annual Meeting « Back

Takotsubo (Stress-Induced) Cardiomyopathy Temporally Associated with Thoracic Epidural Steroid Injection for Postherpetic Neuralgia

Nick McKernan, MD, nickmckernan@gmail.com¹, Bryan Rondeau, MSIV², Russell K. McAllister, MD², (1) University of Utah, Salt Lake City, Utah, (2)Texas A&M Health Science Center, Temple, Texas

Introduction: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a transient systolic dysfunction of the left ventricle typically triggered by an acute illness or intense emotional or physical stress (1). Postherpetic neuralgia (PHN) is pain persisting in the distribution of a herpes zoster infection 6 months after healing of the eruptions (2). Case Report: We present a 77-year-old woman with PHN who was treated with an uneventful, fluoroscopically guided, T4-5 epidural steroid injection (ESI). Previous treatments with ESI, propoxyphene, and gabapentin had provided adequate analgesia. Her medical history also included multiple myeloma, chronic kidney disease, hypertension, hypothyroidism, and degenerative disk disease. Recent psychosocial stressors included her brother’s death and her husband’s nursing home admission. Several hours following the ESI, she developed substernal chest pain, shortness of breath, nausea, and vomiting, and was taken to the emergency department. On evaluation, she had elevated troponin-I levels and electrocardiographic changes suggestive of myocardial ischemia. A transthoracic echocardiogram showed depression of the apex of the left ventricle with apical ballooning, and preserved wall motion of the basal segments. Her ejection fraction (EF) was estimated at 30%. Cardiac catheterization demonstrated no acute occlusive coronary disease and the diagnosis of Takotsubo cardiomyopathy was made. She was admitted, then discharged after 4 days at the hospital. A repeat echocardiogram 20 days later showed no wall motion abnormalities and a normal EF. Conclusion: We present what we believe to be the first documented case of Takotsubo cardiomyopathy temporally associated with thoracic ESI. References: 1)Tsuchihashi, K, Ueshima, K, Uchida, T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarctaion Investigations in Japan. J 2)Mahn, F, Baron, R. Postherpetic Neuralgia. Klin Monbl Augenheilkd. 2010 May; 227(5):379-83.

Funding: None