Takotsubo Syndrome induced by sclerotherapy with polidocanol

Takotsubo Syndrome or stress cardiomyopathy is reversible cardiomyopathy characterized by a sudden onset reversible episode that mimics an acute coronary syndrome; it presents with acute left ventricular dysfunction, ventricular dilation and contractility alteration, but there is no identifiable coronary artery compromise in the angiogram. It usually occurs in post-menopausal women and in some cases might be triggered by an emotional or physical stress episode; this allowed to call it “the broken heart syndrome.” We present an unexpected event in the course of treating a patient with polidocanol foam sclerotherapy, a 71 year-old woman with a sudden onset of chest oppression sensation, dyspnea, nausea and diminishment of visual acuity that began 5 minutes after a session of sclerotherapy while lying on the procedure bed at an ambulatory vascular surgery center. Polidocanol foam was injected in the left lower limb below the knee, to treat varicosities in the context of chronic venous insufficiency. The symptoms resolved spontaneously shortly after the episode and the patient was released. Five hours later, while being lying on her bed at home, a similar but more intense episode occurred. At the ER, the EKG showed sinus tachycardia with no other alterations, Troponin I level in blood showed a frankly positive result. She was diagnosed with non-ST elevation myocardial infarction (NSTEMI) and received the initial management. The percutaneous coronary intervention (PCI) was normal and showed no arterial abnormalities, an echocardiogram revealed left ventricular dysfunction which confirmed the diagnosis of Takotsubo Syndrome. The patient had history of several previous well tolerated sclerotherapy sessions, with no complications. Additionally, the patient was grieving due to the passing of a beloved one two months before.