Key result
Intracavitary brachytherapy triggered Takotsubo syndrome, presenting as cardiopulmonary arrest and reversible left ventricular dysfunction, in a 38-year-old woman with endocervical adenocarcinoma.
Case Report (n=1)
No
Intracavitary brachytherapy may act as a trigger for Takotsubo syndrome in cancer patients, warranting its consideration as a differential diagnosis for acute cardiac events in this population.
Alerts clinicians to possible takotsubo during brachytherapy; case report leaves open causality and incidence.
BACKGROUND: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. CASE REPORT: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. CONCLUSIONS: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.
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Vieira et al. (2020) conducted a case report in Endocervical adenocarcinoma and Takotsubo syndrome (n=1). Brachytherapy was evaluated on Development of Takotsubo syndrome. Intracavitary brachytherapy triggered Takotsubo syndrome, presenting as cardiopulmonary arrest and reversible left ventricular dysfunction, in a 38-year-old woman with endocervical adenocarcinoma.
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