Table 1 Literature review of cases of Takotsubo cardiomyopathy in patients with asthma exacerbation

Kansara et al. [8]

58 years/male

Dyspnea, chest pain, wheezing, psychiatric exacerbation

New RBBB plus Left anterior fasicular block

4.9 ng/ml

Not given

Initial ECHO normal, Repeat ECHO showed LV Apical Ballooning, Patient refused cardiac catheterization

Repeat ECHO 8 weeks later showed resolution of WMA

Agitation due to psychiatric disturbance/asthma exacerbation

Kotsiou et al. [9]

43 years/female

Chest tightness, dyspnea, dry cough,

Salbutamol use 3 times a day prior to admission

Stressful family event the day before

TWI in II, III, AVF

2.2 ng/ml

345 pg/mL

Nebulized bronchodilators, IV steroids, adrenaline given. Pt intubated; repeated bronchodilators, IV steroids, and Magnesium Sulfate; ECHO showed 45% EF and Apical ballooning

Repeat ECHO showed recovery of LV WMA. Cardiac catheterization showed normal coronaries, EF 60%, no WMA

Repeat EKG 2 months after discharge was normal

Epinephrine use, beta agonist in treatment of Status asthmaticus

Ozturk et al. [10]

58 years/female

Dyspnea, chest pain, wheezing

Diffuse ST depression, Precordial TWI

0.672 ng/ml

Not given

ECHO showed hypokinesis of mid/apical segment of intraventricular septum, LV anteroseptal wall, and hyperkinesia of the basal segment, EF 35%

Cardiac catheterization revealed normal coronaries, hypokinesis of LV except bases and apex of LV

Repeat ECHO showed normal EF and no segmental WMA

Physiological stress of  asthma exacerbation

Khwaja et al. [11]

51 years/female

Dyspnea, wheezing; hospitalized for asthma exacerbation 12 days prior

ST elevation in precordial leads + TWI in inferior leads

5.557 ng/ml

9490 pg/mL

Salbutamol/ipratropium nebulizer and IV steroids, IV aminophylline, antibiotics, BiPAP. Cardiac catheterization showed normal coronaries, EF 30% and apical akinesia and basal segment hyperkinesia

Repeat ECHO showed normal LV systolic function and no segmental WMA

Methylxanthines increase Norepinephrine release and trigger negative inotropic response by way of G-protein signaling

Saito et al. [12]

63 years/male

Dyspnea, wheezing

ST elevation V2-V6

With TWI in II, III, AVF, V2-V6

3.45 ng/ml

703.3 pg/ml

Non-invasive ventilation, IV steroids, continuous SABA nebulizer and inhaled anticholinergic. Cardiac Catheterization showed normal coronaries, EF of 49%, and Apical Ballooning

Repeat EKG normal, ECHO with normal EF

LABA Overdose, stress of asthma attack

Marmoush et al. [13]

80 years/Female

Dyspnea, wheezing, left-sided substernal chest pain

New LBBB

1.112 ng/ml

Not given

IV steroids, albuterol/ipratropium plus Aspirin, ECHO showed EF 65% with hypokinesis of LV apex and distal septum. Cardiac catheterization showed apical ballooning

Persistent LBBB; repeat ECHO showed normalized EF, resolution of Apical WMA

Increasing beta agonists use in mild asthma exacerbation

Salahudin et al. [14]

50 years/male

Acute respiratory failure requiring mechanical ventilation

ST elevation in precordial leads

2.29 n/ml

Not given

ECHO showed EF 25–30%, with cardiac catheterization showing normal coronaries, apical dilation and balooning.

Repeat ECHO showed normal EF and no apical ballooning

Albuterol (total of 50 gm of albuterol daily in the preceding 24 h) plus stress of asthma exacerbation

Pontillo et al. [15]

72 years/male

Dyspnea

ST Elevation in anterior leads

Fourfold rise in troponin (values not given)

Not given

ECHO showing apical ballooning and EF 37%

Repeat ECHO showing normal cardiac function

Physiological stress of Asthma exacerbation

Rennyson et al. [16]

66-year old/female

Dyspnea; hypoxia, substernal chest pain

ST Elevation in V1-V4

Initial—normal, second mildly elevated (values not given)

Not given

Emergent cardiac catheterization which showed normal coronaries/EF 15%

Repeat admission 6 months later with same complaints and cardiac findings

High dose beta agonists with continued use, with repeat presentation again at 6 months

Stanojevic et al. [17]

71 years/female

Worsening dyspnea requiring mechanical ventilation

Mild ST Elevation in V2–V3 and prolonged corrected QTc

2.6 ng/ml

Not given

ECHO showed EF of 35% with severe hypokinesis of basal segments; refused cardiac catheterization

4-weeks later EF of 55% and complete resolution of the RWMA

Excessive albuterol use for worsening asthma 5 days prior to admission

Osuorji et al. [18]

46 years/female

Worsening dyspnea requiring mechanical ventilation

ST elevation in inferior and lateral leads

9.56 ng/ml

Not given

Received ketamine and epinephrine to treat bronchoconstriction and developed ST Elevation; Coronaries normal; placed on IABP

Repeat ECHO 3 days later showed normal EF (55%) (Initial EF 10%)

IV epinephrine and ketamine use and status asthmaticus

This study

68 years/female

Dyspnea for 3 days requiring BiPAP, sputum production

LBBB

9.55 ng/mL

20,242 pg/mL

ECHO showed EF 24%, severely depressed LV function, no RWMA

Cardiac Catheterization showed EF 10%, LV, normal coronaries, akinesis of anterior/inferior wall and apex; IABP placed

Repeat ECHO 9 weeks showing normal EF

Status asthmaticus