The Perfect Storm: Takotsubo Cardiomyopathy and Electrical Storm in Patient With AIDS
Document Type
Abstract
Publication Title
Journal of the American College of Cardiology
Abstract
Background: Patients with HIV have an increased risk of sudden cardiac death, with the highest risk in patients with a CD4 count < 200. Arrhythmias are thought to be the cause of cardiac arrest in 20-47% of HIV+ patients, but the data on ventricular storm and HIV infection remains unclear.
Case: A 45 year old female with a history of HIV not on treatment presented with vomiting, diarrhea, and dizziness. Initial EKG showed diffuse ST segment elevation prompting cardiac catheterization which showed non-obstructive coronary artery disease. Echocardiogram revealed mid-to-apical severe hypokinesis of the left ventricle and basal sparing, consistent with Takotsubo cardiomyopathy (TCM). Workup was positive for enteropathogenic E. coli (EPEC). The patient developed electrical storm with numerous episodes of pulseless ventricular tachycardia requiring defibrillation. She was unresponsive to amiodarone and placed on a lidocaine drip, intubated, and sedated. Her CD4 count resulted at 25. She required inotropic and vasopressor support for cardiogenic shock. Her family later decided to pursue comfort measures and she expired six days after admission.
Decision-making: After adjusting for confounding variables, there is no difference in mortality from TCM in HIV+ patients. However, this is not true for ventricular arrhythmias. Patients with HIV are at increased risk for sudden cardiac death, and 20-47% of HIV patients who died of sudden cardiac death had pre-existing history of arrhythmias. Ventricular storm is more likely to occur in patients with underlying structural heart disease, including acute heart failure. Our patient presented with TCM secondary to fulminant EPEC infection in the setting of AIDS. The acute change in her cardiac structure with the increased risk of arrhythmias in the setting of AIDS likely precipitated electric storm and ultimately death.
Conclusion: Sudden cardiac death remains a leading cause of mortality in patients with HIV, with the highest risk with CD4 counts < 200. However, this difference disappears when the CD4 count is above 500. All patients with HIV infection should be strongly encouraged to participate in HAART therapy to reduce their risk of sudden cardiac death.
DOI
10.1016/S0735-1097(24)06492-1
Publication Date
4-2-2024
ISSN
1558-3597
Recommended Citation
Clark C, Miller S, Botrous F, Longnecker CR. The Perfect Storm: Takotsubo Cardiomyopathy and Electrical Storm in Patient With AIDS. Journal of the American College of Cardiology. 2024; 83(13S). doi: 10.1016/S0735-1097(24)06492-1.
