Severe heatstroke complicated with Takotsubo cardiomyopathy

Abstract

Case: A 69 year-old female with history of schizophrenia was transported to our hospital by ambulance due to coma. On arrival, she was hypotensive and tachycardic with a Glasgow coma scale score of 3 and a rectal core temperature of 40°C. Heatstroke was strongly suspected as the cause of the coma and hypotension. Active external cooling with an electric fan and cooled IV fluid administration were started. Her electrocardiogram (EKG) showed ST elevation in V2-6, II, III and aVF. Echocardiography revealed apical ballooning, which indicated Takotsubo cardiomyopathy. Coronary angiography indicated normal coronary arteries.

Outcome: After admission to the intensive care unit, her cardiovascular status gradually improved and she was transferred to the psychiatric ward on day 36.

Conclusion: Heatstroke and Takotsubo cardiomyopathy can share the same pathophysiology. Close evaluation of hemodynamic status and myocardial damage is critical for survival.

Keywords: Circulation; Takotsubo cardiomyopathy; echocardiography; heatstroke; shock.

Figure 1

(A) The electrocardiogram recorded 3 h after arrival showed ST elevation in V2‐6, II, III and aVF. B) The electrocardiogram recorded on day 15 showed negative T wave in V2‐6.

Figure 2

Echocardiography and angiography of the case. The echocardiogram on arrival displays (A) ventricular apical ballooning [arrowheads] with (B) basal hypercontraction [arrows]. Angiography revealed normal coronary arteries. (C) Right coronary angiography. (D) Left coronary angiography.