Rhabdomyolysis causing severe systolic dysfunction Syed Saad MD, Pramilla Subramanian MD, Neeraj Jain MD, Jose Barrientos MD, Brian Allen MD, George Eigbire MD. Rhabdomyolysis (RML) is a syndrome caused by dissolution of skeletal muscles. It results in extravasation of toxic intracellular contents from the myocytes into the circulatory system. Complicated RML cases can be characterized by crush syndrome, acute renal failure (ARF), disseminated intravascular coagulation (DIC) and multiple organ failure. We present a case of RML causing severe systolic dysfunction with staggering troponinemia, which is rarely reported. A 59-year-old woman with no prior cardiac history who was transferred from an outside hospital for urgent dialysis. She was altered with severe oliguric ARF, transaminitis and metabolic acidosis. Her initial creatine phosphokinase, troponin I and brain natriuretic peptide values were 190000 U/L, > 50.0 ng/ dL and 4067 pg/ml respectively. Her urine drug screen was positive for methamphetamine and opiates. Electrocardiogram (EKG) demonstrated sinus tachycardia with inferolateral ischemic changes (T wave inversions). Transthoracic echocardiogram (TTE) showed severe global systolic dysfunction with grade I diastolic dysfunction. Sepsis work up and inflammatory markers were unremarkable. She underwent hemodialysis and supportive management for RML. Repeat EKG the following day demonstrated resolution of ischemic changes. TTE was repeated after 10 days once she stabilized. It showed persevered systolic function with normal diastolic function. During the hospital course troponin I, renal indices and liver function tests trended down and normalized. She was discharged with cardiology clinic follow up in 2 weeks. Owing to her presentation and severe elevated CPK, RML was suspected to be the cause of her acute systolic heart failure, ARF and acute hepatic injury.
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