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The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.

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We report a new entity of the Takotsubo syndrome. While the classic form of Takotsubo syndrome presents as transient apical ballooning, in reverse Takotsubo syndrome we see just the opposite, i.e. transient dilatation of the basal segments and a hyperkinetic apex. The reverse Takotsubo phenomenon was seen in a 36-year-old female patient who had an injection of lidocaine with adrenaline for plastic surgery of the ear. Coronary artery disease was excluded as the cause of this patient's prolonged chest pain and troponin positivity. Echocardiography revealed akinesis of the basal segments and a hyperkinetic apex. The wall motion abnormalities resolved in three days.

While educating non-medical personnel on acute coronary syndrome we often emphasize the importance of early recognition and urgent transfer to acute cardiac center of patients with acute myocardial infarction. Aside from typical symptoms of chest tightness and pain radiating to shoulder, arm and jaw, angina often presents with atypical, non-cardiac complaints. These symptoms, often suggesting gastrointestinal problems, can sometimes mislead even the most experienced physicians. We would like to present the case of an 83-year-old woman with several decades long history of ischaemic heart disease, who recently developed a new anginal symptom: lound, uncontrollable belching. Within the past eight months she was admitted four times with complaints of belching followed by chest pain. Even though initially it was thought as an incidental finding, in all four cases she had proven coronary occlusion requiring cardiac intervention. Orv. Hetil., 2017, 158(5), 183-186.