Differential Diagnosis of Transient Left Ventricular Dysfunction in a Critically Ill Patient

Abstract

There is evidence illustrating that the etiologies of non-ischemic LV (left ventricular) dysfunction such as Takotsubo cardiomyopathy, neurogenic stunning myocardium and post resuscitation stunning myocardium have a favorable clinical outcome. Good prognosis in non-ischemic LV dysfunction provides us courage to treat the condition expecting good. We describe herein the unique case of a 33-year-old woman who was started on combination chemotherapy of oxaliplatin and 5-flurouracil for colon adenocarcinoma. The patient’s baseline QTc was 460 ms. Twenty-four hours following initiation of chemotherapy, the patient developed 3 discrete episodes of tonicclonic seizures. Electrocardiogram assessment demonstrated a prolonged QTc interval (623 ms) with several episodes of TdP. Two episodes required defibrillation to revert to sinus rhythm. Post resuscitation echocardiogram showed severe global LV dysfunction with ejection fraction of 33%. The patient subsequently required mechanical ventilation due to severe LV dysfunction with pulmonary edema. Possible etiologies for LV dysfunction in the present case include global Takotsubo cardiomyopathy, neurogenic stunning myocardium or post resuscitation stunning myocardium. Repeat echocardiogram 48 h later showed the ejection fraction of 60%. Although myocardial dysfunction associated with Takotsubo cardiomyopathy, neurogenic stunning myocardium and post resuscitation stunning myocardium have been previously described independently, the present case is unique in that, to our knowledge, torsade de pointes presented with transient left ventricular dysfunction following several episodes of seizures and post resuscitation stunning myocardium that were stabilized in one patient following oxaliplatin and 5- fluorouracil infusion has not been reported.