Post-resuscitation myocardial injury or secondary takotsubo syndrome?

• Anastasia V. Sukhareva
• Dmitriy S. Evdokimov
• Natalya A. Platonova
• Svetlana A. Boldueva

Abstract

Determining the cause of myocardial injury in out-of-hospital cardiac arrest with cardiopulmonary resuscitation (CPR) is often challenging.

In this case report, a 50-year-old patient with out-of-hospital cardiac arrest due to ventricular fibrillation and hemodynamic decline was found to have myocardial injury that required differential diagnosis between type 2 myocardial infarction and post-resuscitation myocardial dysfunction (PMD). Nine hours after diagnostic coronary angiography, which revealed the proximal third of the anterior interventricular artery subocclusion without signs of thrombosis and successful stenting, the patient suddenly developed cardiogenic shock caused by transient global myocardial dysfunction. The differential diagnosis was between persistent signs of PMD and secondary takotsubo syndrome (TS). The results of magnetic resonance imaging of the heart with contrast excluded MI and myocarditis, but did not allow for unambiguous confirmation of secondary TS or PDM.

The presented clinical case indicates the need to study the causes and mechanisms of development of acute myocardial injury both after post-resuscitation measures and in secondary TS, which will contribute to improving the differential diagnosis of these conditions and their treatment.

Keywords: postresuscitation myocardial dysfunction; cardiac arrest; myocardial infarction; myocardial injury; secondary Takotsubo syndrome

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