Acute Heart Failure in a Young Patient Treated in ICU-Diagnostic Pitfalls

Abstract

Background:Chlamydia pneumoniae and human herpesvirus 6 (HHV-6) are uncommon aetiological agents in respiratory tract infections and are rarely associated with cardiogenic shock. This case report presents a rare instance of severe cardiomyopathy linked to these infections in a 19-year-old Asian female. The case highlights the importance of considering a broad differential diagnosis in acute heart failure, especially in young adults. Case report: The patient was admitted with chest pain and diagnosed with ST-elevation myocardial infarction (STEMI) based on electrocardiography. She subsequently developed heart failure, with a marked reduction in myocardial contractility and a left ventricular ejection fraction (LVEF) of 20%. Treatment included broad-spectrum antibiotics and inotropic support guided by hemodynamic monitoring, leading to clinical improvement. The patient was discharged in a significantly improved condition following a stay in the intensive care unit (ICU). Conclusions: This case emphasizes the importance of considering Takotsubo syndrome in differential diagnoses, especially in ICU patients presenting with cardiogenic shock, to improve outcomes and reduce mortality through timely and appropriate management. Inotropic support, often used in the ICU to treat hypoperfusion, may worsen outcomes in patients with Takotsubo syndrome by exacerbating basal hypercontractility and prolonging the acute phase through catecholamine receptor activation.

Keywords: Chlamydia pneumoniae; Takotsubo syndrome; cardiomyopathy; myocarditis.

Figure 1

Global longitudinal strain assessment on transthoracic echocardiography. Global longitudinal strain of left ventricle on apical four-chamber, apical two-chamber, and three-chamber views (A), global longitudinal strain of right ventricle (B), and 3D reconstruction of right ventricle ejection fraction (C).

Figure 2

Caption. Management during ICU stay.