A 68-year-old with cranial nerve neuropathies and a troponin rise
We read with interest the case report by Bennett and Iqbal describing a patient thought to have takotsubo cardiomyopathy (TC) induced by varicella zoster viral encephalitis.1 Unfortunately, cardiac magnetic resonance imaging (CMR) had not been available to the authors in the acute setting.
Have the authors considered utilising CMR for patient follow up? CMR represents the ‘gold standard’ imaging modality for the assessment of ventricular size and function. In addition, it would be important in this case to assess left ventricular late gadolinium enhancement (LGE).
The presence of LGE confers a poorer prognosis in both ischaemic and non-ischaemic cardiomyopathies,2 and, in patients with TC, LGE is associated with an increased frequency of cardiogenic shock and increased duration to electrocardiographic normalisation.3
It would, therefore, be important to consider CMR not only for diagnostic purposes, but also as a risk-stratification tool, and to assess the patient's response to evidence-based heart failure therapy.
- © Royal College of Physicians 2018. All rights reserved.
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