Emergency treatment for rare 'broken heart' case

The female patient suddenly developed 'broken heart' syndrome during the emergency treatment for severe traumatic brain injury.

Rare disease

The 108 Military Central Hospital has just admitted a 65-year-old female patient in a coma after falling from a height of 3 meters. The accident happened while she was climbing a ladder.

Patients have symptoms similar to myocardial infarction but not due to coronary artery obstruction

PHOTO: NGOC AN

At the hospital, the patient was diagnosed with severe traumatic brain injury and received intensive care. On the fourth day after admission, the patient suddenly developed symptoms of acute myocardial infarction, with electrocardiographic changes. Echocardiography showed a decrease in ejection fraction (EF) to 56%, left ventricular dilatation, severe hypokinesia in the mid- and apex regions, and elevated cardiac enzyme tests.

Coronary angiography did not reveal obstructive lesions, but cardiac imaging showed typical movement disturbances of takotsubo syndrome, an acute stress cardiomyopathy.

According to Dr. Le Dinh Toan, Head of the Department of Neurological Resuscitation, 108 Central Military Hospital, myocardial dysfunction at various levels has been recorded in patients with traumatic brain injury, especially severe traumatic brain injury. However, the above patient is a rare case in cardiomyopathy, studies around the world also report a rate of less than 1% in cardiomyopathy groups in resuscitation.

"Broken heart", myocardial infarction-like syndrome

Dr. Toan added that takotsubo syndrome, or "broken heart," is a temporary and reversible acute heart failure that causes electrocardiogram changes and increased cardiac biomarkers unrelated to coronary artery disease.

Treatment of the disease is mainly hemodynamic control and enhancement of myocardial contractility without increasing myocardial oxygen consumption. Diagnostic tests for Takotsubo syndrome are based on electrocardiogram, echocardiography, cardiac enzymes, and coronary angiography.

Although recovery is possible, the disease can still lead to severe heart failure, cardiogenic shock and arrhythmia in the acute phase, with recovery lasting from several weeks to several months, requiring monitoring and treatment by a specialist.

A cardiologist also said that "broken heart syndrome" is a form of acute cardiomyopathy, which occurs when the body reacts to extreme stress by releasing excessive catecholamines. In a normal state , the concentration of catecholamines in the blood is always low. When stressed, the body will secrete this hormone in response to stimuli.

This sudden increase in catecholamines causes microvascular constriction and impaired heart function, causing symptoms similar to myocardial infarction, not due to coronary artery blockage as is commonly seen.

In the above case, Dr. Toan noted that the successful diagnosis of this case came from the decision to take an image of the heart chamber, although this is not a routine test. This is a reminder that when treating patients with traumatic brain injury, it is necessary to pay attention and closely monitor the patient's cardiovascular condition, provide accurate diagnostic methods, help treat correctly and promptly, and avoid omissions.