Takotsubo Cardiomyopathy Triggered by Bronchoscopy: A Rare Complication

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Bronchoscopy is a common procedure performed in pulmonary medicine, often in the diagnostic workup of suspected infectious or neoplastic pulmonary processes. Despite its frequent clinical use, it is not an entirely benign procedure. Some of the most common complications following bronchoscopy include bleeding, infection, fever, and laryngospasm. Per the literature, more adverse and life threatening events following bronchoscopy are quite rare. We present an unusual case of bronchoscopy as a likely trigger of Takotsubo Cardiomyopathy (TCM). Case Presentation: A 63-year-old woman with no previous cardiac history presented to our hospital from her primary care physician’s office, after a 6-month history of weight loss, fatigue, and weakness. Her presenting symptoms raised concern for reactivation of a previously latent tuberculosis infection, originally diagnosed six years prior. She had a temperature of 36.6 C, pulse was 103beats per minute, blood pressure 60/40s mmHg, and saturating 96% on room air. Due to her hypotension, she was given a 500cc IV bolus and was started on maintenance IV fluids, with improvement of her blood pressure to 102/62. The patient was admitted under airborne precautions for further workup and management of her symptoms. She underwent diagnostic bronchoalveolar lavage on hospital day 5, which was completed with no apparent complications. However, on hospital day 6, she began to experience nausea, vomiting, and hypotension refractory to fluids. She was found to have a NSTEMI and underwent transthoracic echocardiogram, demonstrating left ventricular ejection fraction of 40% with grade III diastolic dysfunction and akinesis of the mid-left ventricle. Cardiac catheterization was performed and demonstrated mild coronary artery stenosis(40-50)%, which was consistent with takotsubo cardiomyopathy, mid-cavitary variant. Discussion: This case of takotsubo cardiomyopathy was likely to have been caused by bronchoscopy. Although there are no reported cases of TCM caused by bronchoscopy to our knowledge, it was the most significant source of stress preceding the patient’s diagnosis. Though the mechanism is technically unknown, TCM is thought to be related to a catecholamine surge and is typically related to periods of high psychological or physical stress. One of the risk factor for this patient was severe cachexia with BMI around 14. Despite being unable to predict who may develop rare complications, it is important for clinicians to keep in mind that even seemingly innocuous procedures can induce a stress response in patients that could lead to the development of takotsubo cardiomyopathy.

Volume

211

First Page

A1999

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A1999

DOI

10.1164/ajrccm.2025.211.Abstracts.A1999

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