Recurrent Takotsubo syndrome complicated with ischemic enteritis successfully treated by hydration: a case report

Figures

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  Fig. 1. “Four months before hospitalization, the patient underwent left ventriculography and was diagnosed with Takotsubo syndrome.” Coronary angiography 4 months previously showed no significant stenosis. Left ventriculography showed wall motion abnormality centered on the left central ventricle, with ballooning of the apical portion.

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  Fig. 2. “Clinical course”. The electrocardiogram revealed negative T waves in many leads (I, II, III, aVL, aVF, V2, V3, V4, V5, V6). Blood examination showed that her brain natriuretic peptide (BNP) levels had risen to 1578 pg/mL (healthy upper limit 18.4 pg/mL). Her blood urea nitrogen (BUN) and creatinine levels had risen to 26.1 mg/dL (healthy upper limit 20.0 mg/dL) and 0.87 mg/dL (healthy upper limit 0.79 mg/dL), respectively. Echocardiography showed wall motion abnormality centered on the left central ventricle, with ballooning of the apical portion. We suspected the recurrence of TTS. As a treatment, we gave the patient a small amount of oxygen (2 L/min). She also received 10,000 units/day of continuous intravenous heparin for 2 days to prevent left ventricular thrombosis and fluid replacement of 1500 mL/day to treat TTS. Although her body weight increased temporarily, the urine volume was normal, oxygenation was stable, and exacerbation of heart failure was not observed. The BNP level also showed a downward trend; hence, diuretics were not administered and hydration was continued. The BNP level and myocardial wall motion were normalized on the fourth day after admission. She was…

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  Fig. 3. “Hypothesis mechanism of Takotsubo syndrome.” Hydration is known to increase the rate of coronary blood flow, and coronary shear stress induces coronary vasodilation via endothelial type nitrous oxide synthase (eNOS). Proper hydration was performed to increase coronary blood flow as an acute treatment for Takotsubo syndrome