Clinical Report: A broken heart courtesy of the flu

Overview

A Cureus case report describes a 67-year-old woman who developed Takotsubo cardiomyopathy two weeks after testing positive for influenza A. Her presentation resembled acute coronary syndrome, but angiography showed nonobstructive coronary disease and ventriculography demonstrated characteristic apical hypokinesis with hyperdynamic basal segments. The report notes that recovery commonly occurs within 3 to 4 weeks, while serious complications can occur.

Background

Takotsubo cardiomyopathy is an acute, typically transient form of left ventricular systolic dysfunction with regional wall-motion abnormalities that extend beyond a single coronary territory. ESC guidance describes the syndrome as usually occurring without obstructive coronary disease and notes that physical or emotional stress may precede it. Because its presentation can resemble acute coronary syndrome, evaluation in this case included ECG, cardiac biomarkers, echocardiography, and coronary catheterization. Influenza-associated Takotsubo cardiomyopathy is described in case-based literature.

Data Highlights

Key Findings

• The patient initially presented with cough, body aches, back pain, chest pain, and gastrointestinal distress; a rapid test confirmed influenza A, and she was discharged with oseltamivir.
• Two weeks later, she returned with exertional chest pain and shortness of breath, followed by sudden chest pain radiating down her left arm.
• ECG showed widespread T-wave inversions, troponin I peaked at 1.4 ng/mL, and echocardiography showed an ejection fraction of 30%.
• Cardiac catheterization found nonobstructive coronary artery disease; left ventriculography showed severe apical hypokinesis with hyperdynamic basal segments, described as classic features of Takotsubo cardiomyopathy.
• Initial treatment included aspirin, clopidogrel, and intravenous heparin; she was subsequently prescribed a statin and an angiotensin-converting enzyme inhibitor and discharged with prompt cardiology follow-up.
• The case report states that full recovery typically occurs within 3 to 4 weeks, but potential complications include heart failure, cardiogenic shock, arrhythmias, and thrombosis.

Clinical Implications

In this case, the acute coronary syndrome-like presentation was evaluated with ECG, biomarkers, echocardiography, and coronary catheterization, which identified Takotsubo cardiomyopathy rather than obstructive coronary disease. The patient was discharged with cardiology follow-up; the report identifies heart failure, cardiogenic shock, arrhythmias, and thrombosis as potential complications.

Conclusion

This case report describes Takotsubo cardiomyopathy occurring after influenza A infection, with diagnostic findings distinguishing it from obstructive coronary disease. The report also notes a usual recovery period of 3 to 4 weeks and the possibility of serious complications.

Related Resources & Content

1. Case report authors, Cureus, Year not provided — When the Flu Breaks the Heart: A Case Report of Influenza A-Induced Takotsubo Cardiomyopathy
2. European Society of Cardiology, European Heart Journal, 2023 — 2023 ESC Guidelines for the management of cardiomyopathies
3. mdspire news — Medical Oddities: The ghost that haunted a heart
4. MDSpire News — Medical Oddities: Plague, Still a Thing
5. MDSpire News — Medical Oddities : A Chest Story Sharp as a Knife
6. ADA News — Connection between flu, heart attacks explored
7. When the Flu Breaks the Heart: A Case Report of Influenza A-Induced Takotsubo Cardiomyopathy
8. 2023 ESC Guidelines for the management of cardiomyopathies
9. Therapeutic Strategies for Takotsubo Syndrome: A Comprehensive Clinical Review.