CONGRESS ABSTRACT

INTRODUCTION Takotsubo Syndrome (TTS) is a form of acute cardiomyopathy characterized by a transient left ventricular (LV) dysfunction that pops out with clinical and electrocardiographic(ECG) features resembling myocardial infarction. While the exact mechanism remains unknown, it is hypothesized that TTS is caused by an excessive release of cardiac neuronal and systemic catecholamines in individuals exposed to physical or emotional stress. CASE REPORT A 75-year-old woman with a medical history of hypertension and diabetes mellitus was referred to the Cardiology Department with the indication to implant a pacemaker after the evidence of advanced atrioventricular block at the ECG-Holter. On admission the first ECG showed sinus bradycardia at 41 bpm, first-degree atrioventricular block and right bundle branch block. A Transthoracic Echocardiogram (TTE) revealed preserved systolic function with a LV ejection fraction (EF) of 70%. The following day the patient underwent dual-chamber PMK implantation via left axillary access and under local anesthesia with lidocaine. The procedure was well tolerated and completed without complications. A chest X-ray was performed and excluded the presence of pneumothorax. Ten hours later the patient complained about chest pain associated with cold sweating and nausea. The ECG showed an electrically induced ventriculogram. Blood tests revealed the elevation of myocardial necrosis indices while the TTE showed left ventricular dysfunction (EF 30%) with akinesia of the apex and middle segments and moderate mitral valve regurgitation. The patient was subjected to an emergency coronary angiographic study which reported no angiographic stenosis. For the diagnostic suspicion of Takotsubo Syndrome, the patient was admitted to the Cardiac Intensive Care Unit, where she was treated with Levosimendan and diuretic therapy with progressive clinical and instrumental improvement. TTE was performed after one week and showed an improvement of the LV systolic function. She was then discharged in good clinical conditions. CONCLUSION Although uncommon, some cases of TTS post-PMK implantation have been described in the literature and in most cases with a good clinical course. The typical ECG-graphic signs are masked by the electrically induced ventriculogram, preventing immediate recognition of the problem. Our clinical case highlights the importance of considering pacemaker implantation as a potential stressful trigger event for TTS.