Tako Tsubo Cardiomyopathy in a 13-Year-Old Boy

Background: Tako Tsubo cardiomyopathy is defined as acute and usually reversible severe left ventricular dysfunction mimicking acute coronary syndrome and based on intensive emotional or physical stress causing catecholamine excess. Therefore, it is also known as “broken heart syndrome.” Traditionally it is most common in postmenopausal women, whereas only few cases have been described in childhood.

Case Report: We report the case of a 13-year-old boy presenting in the emergency department (ED) with afebrile illness and fatigue, a sore throat, and pain in head and neck. While on admission, he suddenly collapsed with dramatically deteriorating cardiovascular parameters resulting in severe cardiogenic shock on the verge of requiring extracorporeal life support (ECLS) due to drastically impaired left ventricular function (FS < 10%) resulting in ventilation and high-catecholamine support. Cardiac catheterization including coronary examination and endomyocardial biopsy was performed without pathological results (i.e., no myocarditis). Within few days, cardiac function recovered to the point of normalization. During the weaning process, he presented with mild hemiparesis and the absence of cough reflex. Subsequent cerebral imaging revealed a brainstem bleeding only few days old based on a fistulous arteriovenous malformation. After endovascular coiling and subsequent microsurgical resection of the malformation, he recovered completely.

Conclusion: In retrospect, the precipitating stressor of this acute ventricular impairment presenting as Tako Tsubo cardiomyopathy could be identified as the brainstem bleeding. Severe ventricular impairment has been described in many adult patients with acute and severe subarachnoid hemorrhage; in children, however, this entity is extremely rare. When diagnosing Tako Tsubo cardiomyopathy in children, precipitating factors, such as intracranial processes, should be ruled out on a regular basis.