From Pancreas to Heart: Takotsubo Cardiomyopathy Following Acute Pancreatitis

Abstract

In cases of severe acute pancreatitis, clinicians must maintain a vigilant approach toward potential cardiac complications, particularly when confronted with unexplained electrocardiographic changes or modest elevations in cardiac biomarkers such as troponin. This report presents a compelling example, detailing the clinical course of a 62-year-old woman who arrived at the emergency department with acute-onset, intense epigastric pain radiating to the back, accompanied by worsening nausea and multiple episodes of non-bilious, non-bloody vomiting. Though her cardiac symptoms were limited to subtle palpitations and mild dyspnea, further evaluation revealed mildly elevated troponin levels, a known systemic inflammatory trigger, and hallmark echocardiographic findings of apical ballooning with basal hyperkinesis—collectively fulfilling the diagnostic criteria for Takotsubo cardiomyopathy (TCM). This diagnosis demanded a nuanced management strategy, balancing the need for intravenous fluid resuscitation to support pancreatic perfusion against the risk of precipitating or exacerbating left ventricular dysfunction. Continuous ECG surveillance and echocardiographic assessment of ventricular filling were essential to guide volume status and avoid complications such as iatrogenic pulmonary edema or potentially life-threatening arrhythmias, including QT prolongation—particularly in the context of antiemetic therapy with agents such as ondansetron. The patient was managed conservatively for pancreatitis, while cardiac dysfunction was addressed with a short course of beta-blockers and angiotensin-converting enzyme inhibitors, titrated carefully in accordance with hemodynamic parameters. This case underscores the increasingly recognized association between systemic inflammatory states and stress-induced cardiomyopathy, revealing a notable gap in current clinical guidelines and emphasizing the critical need for increased diagnostic vigilance and interdisciplinary coordination in managing such complex presentations.