Saving the life of a patient with a rare "broken heart" syndrome

Thanks to emergency inter-hospital coordination and timely intervention using the veno-arterial extracorporeal membrane oxygenation (VA-ECMO) system, a female patient with Takotsubo cardiomyopathy (also known as “broken heart syndrome”), a particularly rare condition, was miraculously brought back from the brink of death.

On October 28, Cho Ray Hospital ( Ho Chi Minh City) announced that it had received a consultation invitation from Tu Du Hospital regarding the case of a female patient named VTB (born in 1983, residing in Dak Lak province) who had suffered cardiac arrest twice during surgery to treat a medical condition. During the waiting period, the Tu Du Hospital team made active efforts to resuscitate the patient and help her heart beat again.

At the same time, the team from the Cardiology Department of Cho Ray Hospital was also present at Tu Du Hospital immediately, assessed the patient's condition and initially diagnosed severe cardiogenic shock, requiring emergency circulatory support. The patient was quickly maintained with minimal hemodynamics, intubated, put on a ventilator... and transferred to Cho Ray Hospital in critical condition.

Female patients with Takotsubo cardiomyopathy (a rare “broken heart syndrome”) are particularly rare.

At the Cardiovascular Intensive Care Unit of Cho Ray Hospital, the patient was recorded as having severe cardiogenic shock, with very high cardiac enzymes (Troponin I peak ~17,770 ng/L). Coronary angiography results were normal, echocardiography showed apical akinesis, basal hyperkinesis, and ejection fraction reduced to only about 33% - a typical form of Takotsubo cardiomyopathy - a type of stress-induced cardiomyopathy that is easily confused with acute myocardial infarction and can progress rapidly, leading to fulminant circulatory failure.

Faced with the critical situation, the team of the Department of Internal Medicine and Cardiology conducted an emergency consultation with the Department of Interventional Cardiology and the Emergency Department of Cho Ray Hospital, and decided to activate the 24/7 extracorporeal heart-lung support procedure, placing an extracorporeal membrane oxygenation system through the vein - artery, creating a "window" for the heart muscle to recover. In parallel, there was a comprehensive resuscitation strategy: hemodynamic control, mechanical ventilation to protect the lungs, antibiotics as recommended and multi-organ support.

Thanks to the good response to intensive treatment, blood pressure and heart activity gradually stabilized... Currently, after several days of treatment, after a near-death experience, the patient has had his endotracheal tube removed, oxygen is given through a canula, vital signs are stable, and vital signs have recovered well.

Prof. Dr. Hoang Van Sy, Head of Cardiology Department, Cho Ray Hospital, shares about the case.

Sharing about the challenging level of the case, Associate Professor, Dr. Hoang Van Sy, Head of the Department of Internal Medicine and Cardiology, Cho Ray Hospital, said that this is a case of Takotsubo cardiomyopathy with a very severe and sudden progression... Regarding this rare "broken heart" syndrome, the Head of the Department of Internal Medicine and Cardiology, Cho Ray Hospital, said that Takotsubo cardiomyopathy can be triggered by physical or psychological stress, especially in patients undergoing major surgery. However, only less than 10% of Takotsubo cardiomyopathy cases lead to acute circulatory failure. Therefore, this is a very rare clinical case.

Therefore, through this case, experts recommend that cardiovascular diseases are increasingly diverse and unpredictable, and can appear in situations of physical or mental stress. Therefore, for women, especially in the pre-menopausal and post-menopausal stages, it is necessary to be vigilant when experiencing symptoms of chest pain, shortness of breath after physical or mental stress or after surgery. This could be a sign of dangerous cardiovascular diseases such as myocardial infarction or Takotsubo cardiomyopathy.

In addition, cases of Takotsubo cardiomyopathy with severe cardiogenic shock complications need to be cared for and treated at centers capable of performing mechanical circulatory support techniques such as extracorporeal cardiopulmonary support systems.

Source: https://cand.com.vn/y-te/cuu-song-benh-nhan-mac-hoi-chung-trai-tim-tan-vo-hiem-gap-i786111/