Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 4 ( April, 2022 ) > List of Articles


Epidural Steroid Injection—Procedure-related Stress (Takotsubo) Cardiomyopathy: A Rare Case

S Prashanth, Pradeep M Venkategowda

Keywords : Cardiomyopathy, Epidural steroid, Stress, Takotsubo

Citation Information : Prashanth S, Venkategowda PM. Epidural Steroid Injection—Procedure-related Stress (Takotsubo) Cardiomyopathy: A Rare Case. Indian J Crit Care Med 2022; 26 (4):526-527.

DOI: 10.5005/jp-journals-10071-24179

License: CC BY-NC 4.0

Published Online: 13-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Stress cardiomyopathy/Takotsubo cardiomyopathy (TC) is a transient and reversible acute heart failure provoked by physical or emotional stress. This case report highlights about a patient who experienced sudden onset chest pain and breathlessness following epidural steroid injection for pain secondary to prolapsed intervertebral disc. Initial clinical features, electrocardiogram, troponin levels, and transthoracic echocardiography showed features suggestive of acute coronary syndrome but the coronary angiogram was normal. The diagnosis of stress cardiomyopathy was made and managed successfully. This case report highlights one of the rare cases of procedure-related early stress cardiomyopathy. Early diagnosis and management reduce morbidity and mortality.

  1. Templin C, Ghadri JR, Diekmann J, Johanna D, Christian NL, Dana RB, et al. Clinical features and outcomes of takotsubo (Stress) cardiomyopathy. NEJM 2015;373(10):929–938. DOI: 10.1056/NEJMoa1406761.
  2. Nicholas PM, Bryan JR, Russell KM. Stress-induced (takotsubo) cardiomyopathy following thoracic epidural steroid injection for post herpetic neuralgia. Proc (Bayl Univ Med Cent) 2014;27(2):120–121. DOI: 10.1080/08998280.2014.11929079.
  3. Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18(1):8–27. DOI: 10.1002/ejhf.424.
  4. Sato HTH, Uchida T, Dote K, Ishihara M. Takotsubo-like left ventricular dysfunction due to multi-vessel coronary spasm. Kaga Kuhyoronsh Publishing; 1990. p. 56–64.
  5. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352(6):539–548. DOI: 10.1056/NEJMoa043046.
  6. Lee JW, Kim JY. Stress-induced cardiomyopathy: the role of echocardiography. J Cardiovasc Ultrasound 2011;19(1):7–12. DOI: 10.4250/jcu.2011.19.1.7.
  7. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155(3):408–417. DOI: 10.1016/j.ahj.2007.11.008.
  8. Brunetti ND, Santoro F, De Gennaro L, Correale M, Kentaro H, Gaglione A, et al. Therapy of stress (takotsubo) cardiomyopathy: present shortcomings and future perspectives. Future Cardiol 2016;12(5):563–572. DOI: 10.2217/fca-2016-0014.
  9. Santoro F, Ieva R, Ferraretti A, Ienco V, Carpagnano G, Lodispoto M, et al. Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: a case series. Cardiovasc Ther 2013;31(6):133–137. DOI: 10.1111/1755-5922.12047.
  10. Singh K, Carson K, Shah R, Sawhney G, Singh B, Parsaik A, et al. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. Am J Cardiol 2014;113(8):1420–1428. DOI: 10.1016/j.amjcard.2014.01.419.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.