Nightmare as a trigger for stress cardiomyopathy

Abstract

A 67-year-old female was admitted to the emergency department with moderate dyspnea that escalated into oppressive chest pain after 4 hours. She had mild hypertension (153/107 mmHg) and sinus tachycardia (110 bpm). The electrocardiogram showed a left axis deviation without any signs of ischemia and a corrected QT interval of 471 ms (Fig. 1A). The biological markers showed a N-teminal-pro-B-type natriuretic peptide level of 1513 ng/L, peak troponins of 3502 ng/L, and peak creatine kinase of 306 U/L. The transthoracic echocardiogram (TTE) showed severe apical dysfunction with a left ventricular ejection fraction (LVEF) of 25% (Fig. 1B, Suppl. Video 1, Part 1 ). A left ventriculography (Fig. 1C, Suppl. Video 1, Part 2 ) and coronary angiography (Fig. 1D, E)