A Unique Case of Recurrent Takotsubo Cardiomyopathy

Abstract

Takotsubo (stress induced) cardiomyopathy is also known as broken heart syndrome or transient left ventricular apical ballooning syndrome. The clinical presentation, which mimics acute myocardial infarction, is preceded by intense emotional or physical stress. Recurrence of apical ballooning syndrome seems to be rare. We present a case of recurrent takotsubo cardiomyopathy precipitated by relatively mild physical stress. There was full recovery with conservative management. This suggests that there are presently unknown patient-specific characteristics that predispose patients to takotsubo cardiomyopathy.

An unusual cause of recurrent chest pain in an adult woman: a case of recurrent stress-induced (Takotsubo) cardiomyopathy

“…Involvement of the right ventricle has been described and is found to be associated with lower LVEF, longer hospitalisation, more frequent complications like congestive heart failure, need for intra-aortic balloon pump support or cardiopulmonary resuscitation 18. As in this case, even the recurrent cases have favourable prognosis with the conservative management 9 10Learning points

Takotsubo cardiomyopathy mimics acute coronary syndrome and is usually precipitated by intense physical or emotional stress.

The diagnosis requires coronary angiography to exclude coronary artery disease.

Prognosis is generally favourable even in recurrent cases.

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“…On echo cardiogram TCM typically presents with marked left ventricular dysfunction that is in a greater distribution than that of a single coronary vessel, however cardiac catheterization typically show normal coronary vessels [1,2,3,5]. What further characterizes TCM is the recovery of EF within days to weeks, with an average EF at follow-up ranging from 60-76% [3,5]. The treatment for TCM is largely supportive and recurrence is rare.…”

“…Patients often have electrocardiogram (ECG) abnormalities that are large in magnitude, most commonly ST segment elevations in the pre-cordial leads and T wave inversions [3,4,5]. Elevated cardiac enzymes are also a common feature, occurring in 86.2% of cases [3,5]. On echo cardiogram TCM typically presents with marked left ventricular dysfunction that is in a greater distribution than that of a single coronary vessel, however cardiac catheterization typically show normal coronary vessels [1,2,3,5].…”

“…Patients often have electrocardiogram (ECG) abnormalities that are large in magnitude, most commonly ST segment elevations in the pre-cordial leads and T wave inversions [3,4,5]. Elevated cardiac enzymes are also a common feature, occurring in 86.2% of cases [3,5].…”

“…It typically occurs in post-menopausal women and may account for up to 2.5% of all patients with acute coronary syndrome (ACS) symptoms [1,2,3,4]. Although a small fraction of patients have no identifiable trigger, TCM is most commonly preceded by an emotional or physical stressor [1,3,4,5].…”