Review for 10.1186/s12876-021-01725-5 (2021)

Reviewer’s report
Title: 
Takotsubo cardiomyopathy complicating acute pancreatitis: a case report
Version: 
0 
Date: 
10 Feb 2021
Reviewer's report:
In this paper, Yeh and Carroll present a rare case of tako-tsubo cardiomyopathy
(TCM) induced by acute alcoholic pancreatitis in a 27-year young male. The
authors describe the initial presentation and workup of the patient including the
application of thrombolysis upon the development of clinical and ECG signs
suggestive of an STEMI and the establishment of correct diagnosis via coronary
angiography and left ventriculography. In the discussion the authors go over the
thus far very rare reports of acute pancreatitis-associated TCM and point out the
uniqueness of their case which lies in the significantly younger age (and also
male sex) of their patient. The authors conclude by stressing the importance of
recognizing this complication of acute pancreatitis, as it can otherwise be
associated with unnecessary and potentially dangerous treatment interventions
(thrombolysis) especially in settings where coronary catheterisation is not readily
available.
The paper is well written and the case is presented clearly and concisely and is
certainly worth publishing given its rarity and potential clinical implications. 
Minor comments:
1. The authors point out the potential role of echocardiography in diagnosing
TCM. Was echocardiography available at the admission hospital? If so, was it
considered before applying thrombolysis?
2. Was the history of the patient in any way suggestive of increased risk of acute
coronary syndrome (e.g. arterial hypertension, dyslipidemia, diabetes mellitus...)
- especially in the light of the present coronary artery disease (even though non-
obstructive)? Adding more details about patient's history as well as further
biochemical parameters from the initial work-up (including lipids, renal
functions and CRP) would allow for a better clinical picture of the patient. Was
the rate of coronary stenosis seen in coronarography quantified?
3. Was there any change in ECG after thrombolysis or at admission to Coronary
Unit as compared to the initial one, suggesting any potential effect of
thrombolysis? Did the ECG change upon discharge?
4. Adding the results of the 3-month follow-up including echocardiography
would be of interest, should they already be available.
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