An Association of Takotsubo Cardiomyopathy with Guillain-Barré Syndrome

Abstract

Background: The association between Guillain-Barre 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.