Re-initiation of Ozempic at a higher dose precipitated severe nausea and vomiting, leading to physiological stress and subsequent Takotsubo cardiomyopathy in a 56-year-old female.
Case Report (n=1)
Can semaglutide initiation or dose escalation induce Takotsubo cardiomyopathy?
Severe gastrointestinal side effects from semaglutide dose escalation can cause significant physiological stress, potentially precipitating Takotsubo cardiomyopathy in susceptible individuals.
Abstract Introduction Takotsubo cardiomyopathy, commonly known as broken heart syndrome, is a transient, reversible form of heart failure characterized by acute left ventricular dysfunction, typically in the absence of obstructive coronary artery disease. About 85% of cases are precipitated by intense stress. The following describes a case of takotsubo cardiomyopathy induced from initiation of Ozempic. Case description A 56-year-old female with a past medical history of hypothyroidism, hyperlipidemia, fatty liver disease, and menopause on estradiol hormone replacement therapy presented with intractable nausea and vomiting. She has been on Semaglutide (Ozempic), a glucagon-like peptide-1 agonist, and experienced a forty-pound weight loss over the past year. After discontinuation and subsequent re-initiation at a higher dose, she developed significant nausea and vomiting. On presentation, her baseline troponin was elevated at 4771 ng/L, rising to 6742 ng/L at 2 hours. EKG showed slight ST elevation in lead aVR with mild ST depressions in the inferior and lateral leads, raising concern for myocardial ischemia. She was started on heparin and nitroglycerin drips with subsequent symptomatic improvement. The following day left heart catheterization revealed angiographically normal coronary arteries, but posterolateral wall motion abnormalities consistent with acute non-ischemic cardiomyopathy. The patient was started on aspirin, a beta blocker, an angiotensin receptor blocker (ARB), and a statin. Discussion The side effects of Ozempic must be closely monitored, particularly during initiation and dose escalation. A common adverse effect of Ozempic is nausea and vomiting, which can lead to significant volume depletion and impose severe physical stress on the body. In rare cases, this physiological stress may precipitate Takotsubo cardiomyopathy, especially in susceptible individuals. To minimize risk, it is essential to start at the lowest effective dose, titrate gradually, and closely monitor for gastrointestinal symptoms, especially during re-initiation or dose increases. This abstract is funded by: None
Shah et al. (Fri,) conducted a case report in Takotsubo cardiomyopathy (n=1). Ozempic (Semaglutide) was evaluated on Takotsubo cardiomyopathy. Re-initiation of Ozempic at a higher dose precipitated severe nausea and vomiting, leading to physiological stress and subsequent Takotsubo cardiomyopathy in a 56-year-old female.