[Tako-tsubo cardiomyopathy in a man with cerebral haemorrhage].

BACKGROUND

The Tako-Tsubo syndrome is characterized by a transient left ventricular dysfunction in the absence of obstructive coronary disease, typically precipitated by severe emotional or physical stress. It is characterized by a balloon-like left ventricular appearance on angiography, ECG changes, and elevated cardiac biomarkers. We describe a case, where Tako-Tsubo cardiomyopathy was diagnosed in a patient with subarachnoid haemorrhage.

CASE REPORT: A 57-year-old man was brought to the hospital after cardiac arrest and successful resuscitation. After admission, echocardiography was performed that revealed marked impairment of contractility of the left ventricle with akinesis of the apex, interventricular septum, and anterior wall. Subsequent coronary angiography revealed neither coronary pathology nor pulmonary embolism; however, ventriculography showed typical dynamics of the Tako-Tsubo syndrome. Because of a deep cerebral coma (GSG 3), a CT-scan was performed that revealed subarachnoid haemorrhage with a haemotoma in the left temporal lobe, together with symptoms of massive cerebral oedema. The patient died eight days later despite vigorous intensive care. During the autopsy, a ruptured aneurysm of the left central cerebral artery was found.

CONCLUSIONS

The Tako-Tsubo syndrome may occur not only during serious stress but also after resuscitation of cardiac arrest following cerebral bleeding.