{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T20:02:30Z","timestamp":1783972950203,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,10,4]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>A woman with a history of chronic idiopathic constipation and remote eating disorders presented to our hospital with generalised weakness and confusion due to severe hypokalaemic rhabdomyolysis. Her initial ECG showed down-sloping ST segment elevations consistent with the \u2018shark fin\u2019 sign, and initial echocardiography was consistent with Takotsubo cardiomyopathy (TCM). She later developed hypotension, hypoxaemia and low central venous oxygen saturation consistent with cardiogenic shock. A repeat ECG demonstrated the \u2018spiked helmet\u2019 sign, and repeat echocardiography showed new global hypokinesis. She was successfully supported with dobutamine on recognition of her worsening cardiomyopathy. This case highlights how the combination of recognised triggers of TCM such as hypokalaemia and rhabdomyolysis may predispose patients to a more morbid cardiac course and how the severity of such triggers may also influence cardiac morbidity. We additionally highlight the prognostic significance of two ECG patterns associated with TCM.<\/jats:p>","DOI":"10.1136\/bcr-2024-261456","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T19:50:19Z","timestamp":1729194619000},"page":"e261456","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Takotsubo cardiomyopathy and cardiogenic shock due to hypokalaemic rhabdomyolysis"],"prefix":"10.1136","volume":"17","author":[{"given":"Erica","family":"Hwang","sequence":"first","affiliation":[{"name":"Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sathvik","family":"Namburar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Siegel","sequence":"additional","affiliation":[{"name":"Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6910-5554","authenticated-orcid":false,"given":"Andrew","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,17]]},"reference":[{"key":"2025082708325472000_17.10.e261456.1","first-page":"272","article-title":"Rhabdomyolysis: a review of the literature","volume":"67","author":"Khan","year":"2009","journal-title":"Neth J Med"},{"key":"2025082708325472000_17.10.e261456.2","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1161\/CIRCULATIONAHA.121.055854","article-title":"Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications","volume":"145","author":"Singh","year":"2022","journal-title":"Circulation"},{"key":"2025082708325472000_17.10.e261456.3","article-title":"Electrolyte Disorders as Triggers for Takotsubo Cardiomyopathy","volume":"5","author":"Andreozzi","year":"2018","journal-title":"Eur J Case Rep Intern Med"},{"key":"2025082708325472000_17.10.e261456.4","article-title":"Severe Hyponatremia-Induced Stress Cardiomyopathy: A Case Report and Review of Literature","volume":"2020","author":"Perera","year":"2020","journal-title":"Case Rep Cardiol"},{"key":"2025082708325472000_17.10.e261456.5","doi-asserted-by":"crossref","unstructured":"Zoltowska DM , Agrawal Y , Kalavakunta JK . 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