Early Point-of-Care Ultrasound Identification of Stress (Takotsubo) Cardiomyopathy in a Patient with Mixed Septic and Cardiogenic Shock
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-8-2026
Abstract
Stress-induced cardiomyopathy is a reversible form of acute left ventricular systolic dysfunction often triggered by intense emotional or physical stress and may mimic acute coronary syndrome. It has been increasingly recognized in critically ill patients with sepsis, metabolic derangements, and respiratory failure, where it can contribute to acute heart failure and shock. However, early recognition remains challenging in patients with undifferentiated hypoxia and mixed shock physiology, particularly when clinical findings overlap with ARDS and septic shock. This case highlights the diagnostic value of early POCUS in detecting stress cardiomyopathy contributing to respiratory failure and shock and its role in guiding initial management decisions.
A 58-year-old woman with a history of type 2 diabetes mellitus, hypertension, hyperlipidemia, obesity, and obstructive sleep apnea presented to the emergency department with acute shortness of breath, presyncope, and chest discomfort. She was brought in by EMS on CPAP after being found severely hypoxic. On arrival, she was in respiratory distress with diffuse bilateral crackles. Early POCUS demonstrated diffuse bilateral pulmonary B-lines and severe left ventricular systolic dysfunction with regional wall motion abnormalities and preserved right ventricular function. Laboratory evaluation revealed severe diabetic ketoacidosis, elevated high-sensitivity troponin (peak 708 ng/L), markedly elevated pro-BNP (15,000 pg/mL), and later MRSA bacteremia.
Early point-of-care ultrasound enabled rapid identification of stress cardiomyopathy contributing to acute pulmonary edema and shock in a critically ill patient with severe metabolic and infectious stressors. This case highlights the importance of integrating lung and cardiac POCUS in undifferentiated hypoxia and shock, guiding early management decisions and reinforcing the need for serial reassessment as shock physiology evolves.
Recommended Citation
Park M, Johnson J. Early point-of-care ultrasound identification of stress (takotsubo) cardiomyopathy in a patient with mixed septic and cardiogenic shock. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1966