PT  - JOURNAL ARTICLE
AU  - Ari Manuel
AU  - Tom Vale
AU  - Chris Turnbull
AU  - Colm McCabe
AU  - Norman Qureshi
AU  - Annabel Nickol
TI  - Acute cardiomyopathy in rheumatoid associated lung disease
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p3606
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p3606.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p3606.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - A 67 year old lady with rheumatoid arthritis on prednisolone, methotrexate and hydroxychloroquine was admitted with chest pains, breathlessness and blood stained sputum. She had a history of obliterative bronchiolitis and bronchiectasis secondary to rheumatoid, previously treated with cyclophosphamide and Rituximab immunosuppression.An ECG at presentation showed T wave inversion in the anteroseptal leads. Subsequent Troponin I was positive. CT pulmonary angiography revealed no evidence of PE. Antiplatelet agents were commenced. Serial ECGs showed dynamic changes and the patient underwent urgent coronary angiography, which revealed entirely normal coronary arteries but an abnormal left ventriculography.There was marked LV apical hypokinesis and ballooning. Cardiac MRI supported the suspicion of Takutsubo's cardiomyopathy.Discussion: Takutsubo's cardiomyopathy is a cause of cardiac chest pain and troponin release, accounting for up to 2% of ST-elevation myocardial infarction (MI). To our knowledge Takutsubo's is undescribed in patients with rheumatoid bronchiolitis obliterans and bronchiectasis. The similarity in presentation to MI and pulmonary embolism creates diagnostic confusion.Whether the lung inflammation associated with rheumatoid confers an additional risk for Takutsubo's remains unknown. This diagnosis therefore warrants consideration as unnecessary anticoagulation and antiplatelet therapies may have dangerous sequelae.