“Lupus, Marijuana, and Takotsubo: A Perfect Storm”: An Unusual Presentation of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy is a type of myocardial injury that is marked with left ventricular contraction dysfunction. Various regions of the left ventricular wall may exhibit hypokinetic or hypercontractile activity. There is no exact mechanism elucidated for Takotsubo cardiomyopathy, but it is often associated with a triggering stressful event that leads to a catecholamine surge. We describe a 38-year-old female who presented with typical Takotsubo cardiomyopathy, likely in the setting of worsening systemic lupus erythematosus (SLE) exacerbations and excessive cannabis use. The patient described her pain as a tight burning sensation that started on her right side and traveled to the retrosternal/epigastric region and her head. Notable lab values included UDS positive for amphetamines and cannabis, pro-BNP elevation at 1328 pg/mL, and Troponin T elevation at 29 ng/L. Rheumatologic findings were negative for anti-dsDNA and anti-Smith antibodies, but positive for ANA titers greater than 1:1280. A 2D echocardiogram showed an LVEF of 20-25%, apical akinesis and ballooning, and severe left ventricular systolic dysfunction. Prior to discharge, a loop recorder was placed, and the patient was restarted on ivabradine and put on LifeVest monitoring. She was advised to decrease her alcohol and cannabis use. A subsequent echocardiogram taken three months later showed an LVEF of 55-60%, indicating a return of normal cardiac function. We seek to emphasize the importance of minimizing SLE exacerbations in reducing systemic symptoms, as well as the need for further research on the relationships between SLE, heavy cannabis use, and Takotsubo cardiomyopathy.