Takotsubo cardiomyopathy triggered by profound hypoglycemia in a 39-year-old female with anorexia nervosa: strain monitoring of left ventricle function recovery

Anorexia nervosa (AN) is characterized by very low body mass index (BMI), related to obsessive fear of gaining weight, resulting in food restriction. In AN various cardiac complications may occur: hypotension, bradycardia, life-threatening ventricular arrhythmias, pericardial effusion, reduction of left ventricular mass and impairment of its function. Stress-induced takotsubo cardiomyopathy (TC) is reported rarely since sympathetic activity in AN patients is lower than in healthy individuals. Different mechanisms are suggested to be involved in TC pathogenesis, including low estrogens levels or dyselectrolitemia, but hypoglycemia, which results in sympathetic stimulation, seems to be more important.

A case report: The authors describe a case of a 39-year-old female with so far untreated advanced AN, admitted to hospital due to profound hypoglycemia (17 mg/dl), cachexia (BMI 11) and with heart failure. Echocardiography revealed severe left ventricular (LV) dysfunction in the form of apical TC with markedly decreased ejection fraction (28%) and global longitudinal strain (-10.2%). She received therapy focused on metabolic disturbances correction. Daily echocardiography was performed to follow LV function recovery, including longitudinal strain normalization, which was observed after two weeks. TC should be considered as a potential AN complication, but it may be triggered by hypoglycemia of any etiology. Longitudinal strain assessment is a convenient and accurate mode of LV function monitoring in TC patients.