Cytarabine, Venous Catheter Removal, Sepsis, Diagnosis of Malignancy, and Takotsubo Syndrome

Madias criticized in his letter to the editor that we underrate the difficulty of exploring possible triggers of Takotsubo cardiomyopathy (TC) in patients with leukemia in our recently published case report [1]. It is indisputable that causative factors for a TC are multifarious and therefore it is often difficult to identify a clear principle. We agree with Dr. Madias’ comment that in our case several potential triggers were present, such as late effect of cardiotoxic agents, sepsis, or emotional stress, all of which might have been the origin for the highly reduced left ventricular function. The association of TC with malignancies is undisputed, whereas the underlying pathophysiologic mechanism remains unclear. The stress of receiving the life-threatening diagnosis of cancer or an aggravation of the cardiac adrenoceptor sensitivity might be the origin [3]. Dr. Madias is right by raising the objection that we did not focus on specific cardiotoxic side effects of a single chemotherapeutic. However, in addition to listing and discussing all possible triggers for TC in detail, an important aspect was to make this complex disease pattern more known among clinical oncologists, who might not be familiar with this uncommon disease and consider TC into their future differential diagnosis. Stefan Baumann, M.D.