Successful Early Diagnosis of Takotsubo Cardiomyopathy Induced by Status Epilepticus and Pneumonia Following the Exacerbation of Gastroesophageal Reflux Disease: A Case Report

Status epilepticus (SE)-induced Takotsubo cardiomyopathy (TTC) frequently manifests as a hemodynamic compromise, including shock, despite heart failure therapy. This can result in life-threatening events that pose significant diagnostic challenges. We report the case of a 57-year-old woman who was successfully diagnosed with TTC, without hemodynamic compromise, and treated. Two years prior to TTC onset, the patient had exacerbated gastroesophageal reflux disease (GERD) due to recurrent hiatal hernia, accompanied by electrocardiogram (ECG) changes. On the day of TTC onset, the patient developed SE, as well as a high fever due to pneumonia. The SE was resolved by diazepam, and the patient received fluid therapy and antibiotics for the pneumonia. High creatine kinase (CK) and N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels, along with ECG findings (ST elevation in left precordial leads), transthoracic echocardiogram findings (typical apical ballooning), and coronary computed tomography angiography findings (absence of culprit region), confirmed the TTC diagnosis. Although transient mild left ventricular outflow tract stenosis was observed on day 14, it disappeared on day 21. During the course of the disease, the patient received conservative management, with careful monitoring and follow-up imaging, and signs of hemodynamic compromise, such as shock, hypotension, or heart failure, were not observed. The condition was triggered by SE and pneumonia following exacerbation of GERD. The extremely high NT-pro BNP level indicated that the CK elevation was due to myocardial damage rather than SE, facilitating early diagnosis. TTC should be considered when a patient presents with SE and pneumonia following GERD exacerbation and expresses remarkable NT-pro BNP elevation.