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Case Reports in Critical Care
Volume 2015 (2015), Article ID 536931, 5 pages
Case Report

Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax

1Division of Cardiology, Department of Medicine, Woodhull Medical Center, 760 Broadway, Suite 3B320, Brooklyn, NY 11206, USA
2Department of Medicine, Yale-New Haven Hospital, 20 York Street, CB2041, New Haven, CT 06510, USA
3NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
4Division of Cardiology, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
5Saint George’s University School of Medicine, 3500 Sunrise Highway, Great River, NY 11739, USA

Received 5 May 2015; Revised 30 July 2015; Accepted 30 July 2015

Academic Editor: Chiara Lazzeri

Copyright © 2015 Michael Gale et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting. Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10–15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient’s condition improved with a subsequent echocardiogram showing a LVEF of 60%. Conclusion. The patient was found to have Takotsubo cardiomyopathy in the setting of a tension pneumothorax. The exact mechanisms of ventricular dysfunction have not been clarified. However, multivessel coronary spasm or catecholamine cardiotoxicity has been suggested to have a causative role. We suggest that, in our patient, left ventricular dysfunction was induced by the latter mechanism related to the stress associated with acute pneumothorax.