An Association of Takotsubo Cardiomyopathy with Guillain-Barré Syndrome

Background: The association between Guillain-Barré syndrome (GBS) and Takotsubo cardiomyopathy (TC) has been appreciated for over two decades, while the physiological mechanisms between the two conditions are less so. In the time since, the progress in understanding molecular mechanisms and the accumulation of reported cases in the literature together have provided the beginnings for a deeper understanding of the disease pathways connecting these two conditions. Methods: Case report. Results: We report a 75-year-old woman with a history of prior TC who presented with symmetric bilateral paresthesias and weakness all preceded by symptoms concerning for an upper respiratory infection. The patient required intubation shortly after arrival due to respiratory failure, and routine electrocardiogram found evidence of ST-elevation myocardial infarction in multiple leads. Subsequent echocardiogram revealed findings consistent with TC, and electromyographic evaluation confirmed GBS. The patient clinically improved with plasmapheresis and had returned to her cardiac and neurologic baselines on outpatient follow-up. Conclusion: GBS contributes directly to the pathogenesis of TC, both through direct action on cardiac nerves and an increase in resting sympathetic tone. While the stress of intubation likely contributes to a sympathogenic state within GBS, it is unlikely the principal factor predicting the development of TC within this unique subset of patients. TC should be considered in any patient with an acute neuropathy whenever signs of progressive dysautonomia are present. paralysis from autoimmune nerve damage, and Takotsubo Cardiomyopathy (TC), a temporary expansion and paralysis of part of the heart, both are regarded as rare conditions. Their co-occurrence, while rarer still, is common enough for a connection to be considered between the two. Included is an example case of a 75-year-old woman in which they occurred together following a mild upper respiratory illness. The most common reasoning for this connection is emotional stress, which tends to happen when a patient needs mechanical support to breathe. While this explanation may satisfy on an individual basis, it fails to explain larger trends: a TC would be expected in patients who need support breathing, such as the critical care population. After understanding the overlap between these conditions, the autonomic nervous system and the effects of its’ dysfunction in this context must be considered. GBS is capable of directly disrupting the autonomic nervous system, with the resulting dysautonomia potentially severe enough to lead to the development of a TC. Elevated catecholamines, a common result of autonomic dysregulation, should be recognized not only as evidence of a potential underlying dysautonomia, but most importantly as a risk factor for the development of TC. This is especially relevant to the COVID-19 pandemic, where steroids are given to any patient needing more than minimal supplemental oxygen.