Biventricular Reverse (Inverted) Takotsubo/Stress Cardiomyopathy in a Male Patient

Abstract

This report describes the rare occurrence of biventricular reverse takotsubo cardiomyopathy in a male patient who accidentally rolled his tractor trapping his right leg and left chest for 8 hours before being found. At admission, laboratory studies were remarkable for elevated serum troponin, creatine kinase and lactate levels and for acute kidney injury with hyperkalemia and metabolic acidosis. An echocardiogram demonstrated severe biventricular systolic dysfunction with relative preservation of contractility at the apex of both ventricles. Cardiac catheterization showed mild coronary atherosclerosis. The patient was critically ill and hypotensive, requiring vasopressor support and intravenous fluid replacement. He later became anuric with refractory acidosis and hyperkalemia from acute kidney injury due to rhabdomyolysis. Renal replacement therapy was initiated. The patient ultimately expired to multi-system organ failure. Reverse biventricular takotsubo cardiomyopathy is a rare variant of stress cardiomyopathy. Our case suggests that it likely occurs in the setting of a major physical trigger and is associated with severe hemodynamic compromise requiring intensive management, and associated with poor outcomes.