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Assault-induced Takotsubo cardiomyopathy associated with persisting anterograde amnesia and myopathy

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Abstract

Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction, electrocardiographic changes, and minimal release of myocardial enzymes that mimic acute myocardial infarction in patients without coronary artery disease. Takotsubo cardiomyopathy is frequently triggered by emotional or physical stress and occurs primarily in post-menopausal women. The pathomechanism of Takotsubo cardiomyopathy is, so far, unknown. Stress-induced amnesia is probably induced by perturbation of the hippocampal function. Assault-induced Takotsubo cardiomyopathy associated with amnesia has not been reported so far. In a 77-year-old Caucasian female, hospitalized because of confusion, anterograde amnesia, and hypertension after she had been assaulted by a female who sneaked up to her when she was unlocking the door of her apartment, Takotsubo cardiomyopathy was diagnosed based on clinical findings, electrocardiography, echocardiography, and coronary angiography. Follow-up after 8 weeks showed a regression of electrocardiographic and echocardiographic abnormalities; the amnesia for the assault, however, remained unchanged. This case shows that Takotsubo cardiomyopathy may be triggered by emotional stress induced during an assault. Assault-induced stress may not only induce Takotsubo cardiomyopathy but also amnesia for some of the events that occurred during the act.

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Correspondence to Claudia Stöllberger.

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Figure 1

Subsequent ECG recordings on the day of admission (A), after 1 day (B), 2 days (C), and 2 months (D) showing ST changes and changes of the initially normal QT interval from 394 ms (A) to an increase of 528 ms (B), 518 ms (C), and again normalization to 431 ms (D) (JPEG 2927 kb)

High resolution image (TIFF 4449 kb)

Figure 2

Echocardiographic apical four-chamber view (la= left atrium, ra= right atrium, rv= right ventricle, lv = left ventricle). Akinesia of the midseptal and apical parts of the left ventricle was present at admission (a) and normalized after 6 weeks (b) (JPEG 45 kb)

(JPEG 54 kb)

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Stöllberger, C., Sporn, R., Skala, K. et al. Assault-induced Takotsubo cardiomyopathy associated with persisting anterograde amnesia and myopathy. Int J Legal Med 124, 467–470 (2010). https://doi.org/10.1007/s00414-010-0473-1

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  • DOI: https://doi.org/10.1007/s00414-010-0473-1

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