Key result
High-dose bronchodilator therapy for acute COPD exacerbation precipitated an atypical, insidious presentation of stress cardiomyopathy characterized by an absence of chest pain in 5 cases.
Why the study?
Does high-dose bronchodilator therapy for acute COPD exacerbation precipitate an atypical presentation of stress cardiomyopathy?
Case Report (n=5)
Does high-dose bronchodilator therapy for acute COPD exacerbation precipitate an atypical presentation of stress cardiomyopathy?
Stress cardiomyopathy precipitated by COPD exacerbation and high-dose bronchodilators presents atypically without chest pain, highlighting the importance of repeat ECG evaluation to distinguish it from uncomplicated bronchospasm.
May warrant vigilance for stress cardiomyopathy in COPD exacerbations on high-dose bronchodilators; leaves open the spectrum of precipitants and atypical presentations.
Despite a growing awareness of stress (takotsubo) cardiomyopathy, the diversity in precipitants beyond emotional distress remains under-appreciated. Emerging data implicate a differential influence of precipitant type on the variable presentations of stress cardiomyopathy. We outline 5 cases of stress cardiomyopathy where the precipitant was an acute exacerbation of chronic obstructive pulmonary disease treated with high-dose bronchodilator therapy. In this setting, an atypical and insidious presentation of the stress cardiomyopathy was consistently observed that was difficult to distinguish from the acute airway exacerbation itself, with an absence of chest pain in particular. Scrutiny of published single-case reports reveals a similar atypical presentation; this supports the existence of a novel bronchogenic subgroup of stress cardiomyopathy. A key role of repeat ECG evaluation in distinguishing protracted but uncomplicated bronchospasm from bronchogenic stress cardiomyopathy is highlighted. Further data are now required to examine whether high-dose β-agonist therapy is implicated in this association.
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Rajwani et al. (2015) conducted a case report in Stress (takotsubo) cardiomyopathy (n=5). High-dose bronchodilator therapy for acute COPD exacerbation was evaluated on Atypical presentation of stress cardiomyopathy. High-dose bronchodilator therapy for acute COPD exacerbation precipitated an atypical, insidious presentation of stress cardiomyopathy characterized by an absence of chest pain in 5 cases.
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