Tako-Tsubo Cardiomyopathy through Adalimumab

Abstract

A 66-year old woman was admitted with typical clinical signs of angina pectoris. In her history only a chronic rheumatoid arthritis, treated through Adalimumab was reported. The electrocardiograph (ECG) showed sinus rhythm with terminal negative T-waves in V1-V6 without any ST-elevations. Laboratory tests revealed a positive Troponin-I level and the transthoracic echo showed a reduced left ventricular (LV) function by apical akinesia. We immediately performed cardiac catheterization to rule out the suspected coronary artery disease and documented surprisingly a Tako-Tsubo Cardiomyopathy with severe reduced LV function and signs of apical ballooning. Personnel distress, feeling of severe pain, any kind of anger, or anxiety could not be stated in the case history. A further invasive electrophysiological testing ruled out arrhythmias as trigger mechanisms for the Tako-Tsubo Cardiomyopathy. We stopped the Adalimumab therapy and could directly illustrate improved LV function to the normal status under resolved healthy conditions. This is the first time to report Adalimumab as cause for Tako-Tsubo Cardiomyopathy while there is to date literally no direct effect of TNF-alpha antibodies on the myocardium published - lacking any sympathetic nervous stress.