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QT interval prolongation during ECG evolution in takotsubo cardiomyopathy poses a threat of torsade de pointes to predisposed patients

Case report of a female patient with congenital AV block

Bei QT-Intervall-Verlängerung im EKG-Verlauf bei Takotsubo-Kardiomyopathie droht prädisponierten Patienten eine Torsade de pointes

Fallbericht einer Patientin mit kongenitalem AV-Block

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We report the case of a female patient with congenital complete atrioventricular block who developed torsade de pointes (TdP) in the course of takotsubo cardiomyopathy. On the basis of this case, we show that the electrocardiographic evolutionary changes with QT interval prolongation (in the course of takotsubo cardiomyopathy) may be a TdP threatening period in patients with underlying predispositions. After reviewing the literature, we also present the electrocardiographic similarities between takotsubo cardiomyopathy and other acute heart diseases associated with a large amount of stunned myocardium, i.e., other stress-related cardiomyopathies (e.g., those associated with subarachnoid hemorrhage, pheochromocytoma, or severe illnesses) as well as a reperfused myocardial infarction. QT interval prolongation is a common feature in the subacute phase of these entities; however, excessive QT prolongation may be a sign of predisposition to TdP. In such instances, measures should be taken to monitor cardiac rhythm closely and to prevent or treat TdP appropriately. Taking into account the risk of TdP, it is reasonable to consider takotsubo cardiomyopathy as a potential cause of acquired long QT syndrome.


Berichtet wird über den Fall einer Patientin mit kongenitalem atrioventrikulärem (AV-)Block, bei der eine Torsade de pointes (TdP) im Rahmen einer Takotsubo-Kardiomyopathie auftrat. Auf der Grundlage diese Falls wird gezeigt, dass ein Elektrokardiographie(EKG)-Verlauf mit QT-Intervall-Verlängerung (im Rahmen der Takotsubo-Kardiomyopathie) eine Phase erhöhten Risikos für eine TdP bei Patienten mit entsprechender Prädisposition darstellen kann. Nach einer Übersicht über die Literatur werden auch Ähnlichkeiten im EKG zwischen Takotsubo-Kardiomyopathie und anderen akuten Herzerkrankungen beschrieben, die mit einem hohen Anteil reperfundierten, hypokinetischen Myokards („stunned myocardium“) einhergehen, z. B. andere stressbedingte Kardiomyopathien (wie bei Subarachnoidalblutung, Phäochromozytom oder schweren Erkrankungen) oder ein reperfundierter Herzinfarkt. Die QT-Intervall-Verlängerung tritt häufig in der subakuten Phase dieser Erkrankungen auf, eine ausgeprägte QT-Verlängerung kann jedoch Zeichen der Prädisposition zur TdP sein. In solchen Fällen sollten Maßnahmen zur engmaschigen Überwachung des Herzrhythmus und zur Vorbeugung oder angemessenen Behandlung einer TdP ergriffen werden. Angesichts des Risikos einer TdP sollte die Takotsubo-Kardiomyopathie als potenzielle Ursache eines erworbenen langen QT-Syndroms angesehen werden.

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Sacha, J., Wester, A., Hordynski, G. et al. QT interval prolongation during ECG evolution in takotsubo cardiomyopathy poses a threat of torsade de pointes to predisposed patients. Herz 38, 790–795 (2013).

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