Takotsubo cardiomyopathy in a young male with lung cancer and neoplastic embolization of the coronary microcirculation.

ABSTRACT

The associations between stress-induced takotsubo cardiomyopathy (TC) and cancer or its therapy have been studied with increasing interest in recent years. Different mechanisms of TC development in neoplastic disease are suggested, including a decreased threshold for stress stimuli or aggravated heart adrenoreceptors sensitivity. The action of cytokines and reactive oxygen species on the myocardium, on the epicardial arteries as well as on the coronary microcirculation is also taken into consideration. The authors describe a case of a 30-year-old male with lung cancer, after immunotherapy with checkpoint inhibitors followed by two lines of chemotherapy and after pericardial and pleural drainage. He was admitted to hospital due to severe heart failure (HF) with echocardiographic features of apical TC. During symptomatic treatment of HF his state temporarily improved and left ventricular function returned to normal. Unfortunately, a few days later, he died. The autopsy revealed histological features of TC (contraction band necrosis), cardiac infiltration by cancer and the presence of cancer cells in the coronary microcirculation, which was not previously reported in TC patients. The authors emphasize that disseminated neoplastic embolization of the coronary microcirculation may be important in TC pathogenesis in some cancer patients.