Stress-induced Cardiomyopathy Precipitated by Triathlon Competition: A Case Report

Abstract

Stress-induced cardiomyopathy in post-menopausal women is transient and typically precipitated by severe emotional or physical stress. We report a rare case of stressinduced cardiomyopathy mimicking acute coronary syndrome in a middle-aged female triathlete. The initial presentation included chest tightness and dyspnea; however, acute pulmonary edema and cardiogenic shock developed shortly after admission. Electrocardiography showed non-specific ST-T changes and echocardiography revealed severe left ventricular dysfunction with regional wall motion abnormalities. Coronary angiography did not reveal significant coronary artery obstruction. The patient was placed on ventilatory support and administered diuretics and an angiotensin-converting enzyme inhibitor. Follow-up echocardiography on day 3 showed nearly normal left ventricular wall motion with a 54% ejection fraction, and follow-up radiography of the chest revealed no evidence of pulmonary edema. The endotracheal tube was removed on the third day of hospitalization and the patient was discharged two days later without complications.