“Buddenbrook syndrome” - Toothache and its serious consequences

Abstract

Background: Atypical symptoms of acute coronary syndrome are associated with increased mortality due to missed diagnosis and treatment delay. Misleading mandible pain as odontogenic instead of cardiac origin may be termed as Buddenbrook syndrome. The name is derived from Thomas Mann’s (1875-1955) novel Buddenbrooks, where one of the main characters, Consul Thomas Buddenbrook, further complained of jaw pain after teeth extraction and died shortly after due to myocardial infarction.
Case Description: We present a patient with mandible pain, who collapsed at his dentist with the need of prolonged resuscitation due to incessant ventricular fibrillation (VF) caused by acute myocardial infarction. Despite uncertain neurologic prognosis after more than 60 minutes of external cardiopulmonary resuscitation (CPR) and persistent cardiogenic shock 24 hours later we decided to implant an ECMO as the last therapeutic option. The patient improved and could be discharged four weeks later in good neuro- and cardiologic condition.
Clinical Implications: The primary cardiac cause of mandible or toothache may remain undiscovered if teeth also show a correlate for symptoms and may have adverse outcome. Dentists should think of cardiac origin especially in recurrent symptoms or patients with cardiovascular risk factors.