Pol. Merkur. Lek (Pol. Med. J.), 2018, XLV/266: 067-070 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2018, XLV/266: 067-070

Title: Takotsubo cardiomyopathy triggered by influenza B 

Authors: Elikowski W, Małek-Elikowska M, Lisiecka M, Trypuć Z, Mozer- Lisewska I. 

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Takotsubo cardiomyopathy triggered by influenza B

Elikowski W1, Małek-Elikowska M2, Lisiecka M3, Trypuć Z1, Mozer- Lisewska I4,5.

Józef Struś Hospital, Poznań, Poland: 1Department of Internal Medicine, 3Bacteriological Laboratory, 4Department of Infectious Diseases; Poznań University of Medical Sciences, Poland: 22nd Department of Cardiology, 5Department of Infectious Diseases

Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account.

Key words: takotsubo cardiomyopathy, influenza, reversible heart failure

Pol Med J, 2018; XLV (266); 67–70