Thoracic epidural blockade for ventricular tachycardia storm in patient with takotsubo cardiomyopathy

Abstract

Introduction: Takotsubo cardiomyopathy is acute nonischemic myocardial dysfunction of the left and/or right ventricle which usually recovers completely within several days to weeks. We report a case where thoracic epidural analgesia was used to manage sympathetic storm in Takotsubo cardiomyopathy. Case description: A 58-year-old diabetic female who was being treated for urinary tract infection and diabetic ketoacidosis for the past 2 days sustained an episode of pulseless ventricular tachycardia which was treated as per ACLS protocol. Troponin levels were raised, and 2D echocardiography was showing “Takotsubo cardiomyopathy” with typical apical ballooning of the left ventricle at the time of admission, and she was mechanically ventilated and receiving vasopressors. She continued to get episodes of ill-sustained ventricular tachycardia. In spite of conventional management, episodes of ill-sustained ventricular tachycardia continued, and hence, sympathetic blockade with thoracic epidural catheter was administered to control the ventricular tachycardia storm. Conclusion: Sympathetic blockade to treat ventricular tachycardia is a promising approach which needs to be validated with more evidence.