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Case Reports
. 2019 May 1;20(2):52-56.
doi: 10.1016/j.jccase.2019.03.007. eCollection 2019 Aug.

Takotsubo cardiomyopathy associated with Kounis syndrome: A clinical case of the "ATAK complex"

Davide Margonato  1   2 , Raffaele Abete  1   2 , Gabriella Di Giovine  1 , Pietro Delfino  1 , Massimiliano Grillo  1 , Simone Mazzetti  1 , Daniele Poggio  1 , Jessica Rossi  1   2 , Toufic Khouri  3 , Andrea Mortara  1
Affiliations
Case Reports

Takotsubo cardiomyopathy associated with Kounis syndrome: A clinical case of the "ATAK complex"

Davide Margonato et al. J Cardiol Cases. .

Abstract

A 60-year-old female developed cardiac arrest after experiencing an anaphylactic shock during administration of plasma-expanders. An electrocardiogram registered after restoration of sinus rhythm showed mild ST-elevation in the anterior precordial leads and T waves changes followed by appearance of echocardiographic alterations of left ventricular apex kinesis. Coronary angiography revealed normal coronary arteries, and cardiovascular magnetic resonance confirmed apical ballooning with late gadolinium enhancement in the segments with abnormal contractility. This uncommon clinical case confirms how takotsubo and Kounis syndrome may converge in a single nosological entity, the so-called "ATAK complex" (Adrenaline, Tako-Tsubo, Anaphylaxis, and Kounis), with a specific management and prognostic implications. <Learning objective: The Kounis syndrome has a clinical presentation that poses a difficult differential diagnosis with takotsubo cardiomyopathy. Despite recent significant improvements in the understanding of these two clinical conditions, the pathogenesis of these two entities and, in particular, how they may converge into the clinical scenario of the "ATAK complex" remain to be clarified. We believe that this rare clinical case may help physicians in the correct identification and management of this frequently misdiagnosed clinical disease.>.

Keywords: ATAK complex; Anaphylaxis; Cardiac arrest; Kounis syndrome; Takotsubo cardiomyopathy.

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Figures

Fig. 1
Fig. 1
Electrocardiography (ECG) images at admission (A), immediately after CPR (Cardio-Pulmonary Resuscitation) (B), on day 2 (C) and on day 3 (D) from admission. Panel A shows an otherwise normal ECG. Panel B shows mild ST-segment elevation in the anterior precordial leads. Panel C shows resolution of ST-segment elevation. Panel D shows sinus rhythm with negative T waves in the antero-lateral leads and a slightly prolonged QTc (481 ms).
Fig. 2
Fig. 2
Echocardiographic images. Four chambers (upper) and two chambers (lower) images showing diastolic and systolic phase with apical ballooning.
Fig. 3
Fig. 3
Cardiac magnetic resonance late gadolinium enhancement images: mild signal enhancement in the apical segments (see arrows) at the baseline (left side); follow-up images (right side) showing no more evidence of late enhancement.
See this image and copyright information in PMC

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