Acute cardiomyopathy in a patient with acute adnexal torsion.

BACKGROUND

The severe abdominal pain associated with acute adnexal torsion causes physical stress, which may precipitate a clinical syndrome of acute cardiomyopathy mimicking myocardial infarction.

CASE

A postmenopausal woman presented to the emergency department with acute abdominal pain. Clinical and ultrasonographic evaluation suggested acute adnexal torsion. Surgical intervention revealed acute torsion of the right adnexa with marked necrosis and hemorrhage. Preoperative electrocardiogram abnormalities prompted a thorough cardiology workup postoperatively. Decreased ejection fraction on echocardiography prompted immediate cardiac catheterization. Catheterization revealed no significant cardiac disease, consistent with a diagnosis of stress-induced cardiomyopathy.

CONCLUSION

Acute cardiomyopathy can occur as a result of severe pain and stress related to acute adnexal torsion. As gynecologists, it is important to consider stress-induced cardiomyopathy in the differential diagnosis of women presenting with cardiac complaints, especially in the postmenopausal population.