Baylor University Medical Center Proceedings July 2017 - 307

Takotsubo cardiomyopathy with Guillain-Barré syndrome
Dalvir Gill, MD, Vanessa Goyes Ruiz, MD, Ryan Dean, MD, and Kan Liu, MD

Figure 1. Electrocardiogram on admission.

A 70-year-old woman presented with progressive lower extremity weakness and heaviness accompanied with chest pain. Troponin T was elevated, and an echocardiogram showed a left ventricular ejection fraction
of 30% and a hypokinetic left ventricular apex. Neurophysiologic testing
was consistent with Guillain-Barré syndrome, which was treated with
intravenous immunoglobulin therapy. Repeat echocardiogram showed
an improved left ventricular ejection fraction and no left ventricular wall
motion abnormalities. Takotsubo cardiomyopathy is a rare complication
of Guillain-Barré syndrome; less than 10 cases have been reported.

G

uillain-Barré syndrome (GBS) is a relatively uncommon
condition in which the body's immune system attacks
part of the peripheral nervous system (1). It can affect
the nerves that control muscle movement, pain, and
temperature sensation and can be fatal if it affects the respiratory muscles (2). Rarely has it been associated with takotsubo
cardiomyopathy (TC), a transient cardiac syndrome that mimics
acute coronary syndrome. We present an older woman who
developed TC in association with GBS.
Proc (Bayl Univ Med Cent) 2017;30(3):307-308

CASE REPORT
A 70-year-old woman with a history of post-polio syndrome
presented with progressive, worsening lower extremity weakness and heaviness accompanied with chest pain. On presentation she was hemodynamically stable; the electrocardiogram
(Figure 1) did not show any ischemic changes, and her troponin
T level was elevated to 0.42 ng/mL. On admission, two-dimensional echocardiogram showed a left ventricular ejection fraction
of 30% with a severely hypokinetic anterior septum and left
ventricular apex. She underwent cardiac catheterization, which
showed normal coronary arteries and confirmed the hypokinetic
left ventricular walls (Figure 2). She was started on carvedilol
and enalapril. Acute findings were not seen on computed tomography of the head, and her lumbar puncture was normal.
From the Department of Internal Medicine (Gill, Ruiz, Dean) and Division of
Cardiology (Liu), State University of New York Upstate Medical University, Syracuse,
New York.
Corresponding author: Dalvir Gill, MD, Department of Internal Medicine, State
University of New York Upstate Medical University, 750 East Adams Street,
Syracuse, NY 13210 (e-mail: gillda@upstate.edu).
307



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