Takotsubo syndrome as an acute cardiac complication following combined chemotherapy

Abstract

Background: Acute cardiac complications post-chemotherapy is rare. Stress cardiomyopathy, one of these complications, should be considered in differential diagnoses as its symptoms closely resemble those of acute myocardial infarction and can lead to mortality.

Objective: The objective of this paper is to describe Takotsubo syndrome (TTS) as an acute complication following combined chemotherapy in a patient with significant thromboembolic burden and metastatic cervical cancer.

Case: A 61-year-old female patient with a diagnosis of metastatic cervical cancer experienced acute chest pain. Elevated troponin levels and abnormalities in the electrocardiogram initially suggested an acute myocardial infarction, occurring after a chemotherapy session involving Carboplatin and Paclitaxel infusion. Although initial treatment targeted myocardial infarction, further diagnostic evaluations including coronary angiography and cardiac magnetic resonance imaging revealed no coronary artery disease but identified features consistent with stress cardiomyopathy, indicative of Takotsubo syndrome (TTS). This diagnosis led to an improvement in symptoms and a resolution of the acute changes observed.

Conclusion: Stress cardiomyopathy, particularly TTS, is being increasingly recognized as an acute complication associated with combined chemotherapy regimens. The potential cardiotoxic effects of these chemotherapy agents demand careful monitoring and evaluation in patients undergoing oncological treatment, underscoring the importance of integrating cardioprotective strategies into the management of these patients.

Keywords: Carboplatin; Combined chemotherapy; Paclitaxel; Takotsubo cardiomyopathy.

Fig. 1

Admission electrocardiogram (EKG) of patient. This figure displays the patient's ECG upon admission, illustrating ST-segment elevation in leads V2 to V6 and negative T waves. These findings are indicative of significant cardiac stress, characteristic of Takotsubo Cardiomyopathy. The ECG pattern is crucial for differentiating Takotsubo from other acute cardiac events, especially in patients with complex medical profiles.

Fig. 2

Diagnostic Imaging Series for Cardiac Evaluation A: Left coronary artery with TIMI Flow Grade 3. B: Right coronary artery with TIMI Flow Grade 3. C: Cardiac magnetic resonance imaging, 4-chamber cine sequence, diastole. D: Cardiac magnetic resonance imaging, 4-chamber cine sequence, systole with evidence of apical ballooning. E: Cardiac magnetic resonance imaging, 2-chamber cine sequence, diastole. F: Cardiac magnetic resonance imaging, 2-chamber cine sequence, with evidence of apical ballooning in systole.

Fig. 3

Overview of the characteristics of Takotsubo syndrome. This infographic provides an overview of Takotsubo syndrome in the context of chemotherapy, highlighting its characteristics, association with cancer treatments, and the critical need for accurate diagnosis and management in oncological care.