Vulnerable personality and Takotsubo cardiomyopathy consequent to emotional stressful events: a clinical case report

Angelo Compare, Riccardo Proietti, Domenico Del Forno, Alessandra Vitelli, Alessandra Grieco, Luigi Maresca, Francesco Giallauria
  • Riccardo Proietti
    Electrophysiology Laboratory, Luigi Sacco Hospital, Milano, Italy
  • Domenico Del Forno
    Department of Clinical Medicine, Cardiological and Immunological Science, University of Naples Federico II, Italy
  • Alessandra Vitelli
    Department of Clinical Medicine, Cardiological and Immunological Science, University of Naples Federico II, Italy
  • Alessandra Grieco
    Department of Clinical Medicine, Cardiological and Immunological Science, University of Naples Federico II, Italy
  • Luigi Maresca
    Department of Clinical Medicine, Cardiological and Immunological Science, University of Naples Federico II, Italy
  • Francesco Giallauria
    Department of Clinical Medicine, Cardiological and Immunological Science, University of Naples Federico II, Italy

Abstract

Introduction: Although the onset of Takotsubo cardiomyopathy (TTC) can be triggered by an acute, intense emotional stress, the exact pathogenic mechanisms still remain undefined. Presentation: A 58-year-old female was sent by ambulance to the Emergency Department (ED) for chest pain and ST elevations on ECG. Her chest pain began 3 hours before on admission after a domestic argument. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20%. Cardiac catheterization revealed no significant coronary artery disease. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments. A diagnosis of Takotsubo Cardiomyophaty (TTC) was made according to the Mayo Clinic 2008 criteria. The patient evolved with improvement of her condition and, therefore, was discharged from the hospital. Follow-up echocardiogram seven days later showed normal LV size and function with ejection fraction (EF) of 43%. Paykel Life Stress Event Scale identified as emotional trigger a domestic argument occurred 3 hours before symptom onset. History showed a major life stress event, death of a loved one, six months before symptoms. The patient underwent psychological assessment after hospital discharge by Emotional Regulation Questionnaire and BDI showing high suppression/ low reappraisal profile and moderate depression. Conclusion: This case highlights the hypothesis of a possible link between cognitive emotional processing and vulnerability to Takotsubo syndrome.

Keywords

Takotsubo cardiomyopathy, personality traits, stressful event, emotional regulation, emotional trigger

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Submitted: 2015-12-09 15:09:22
Published: 2015-12-09 15:29:38
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Copyright (c) 2015 Angelo Compare, Riccardo Proietti, Domenico Del Forno, Alessandra Vitelli, Alessandra Grieco, Luigi Maresca, Francesco Giallauria

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