Reverse takotsubo cardiomyopathy: two case reports and review of the literature

Abstract

IntroductionReverse takotsubo cardiomyopathy is a rare variant of classic takotsubo cardiomyopathy that presents within a different patient profile and with its own hemodynamic considerations. Its recognition is important for prognostic, evaluation and treatment considerations.Case presentationCase 1: A 69-year-old Caucasian woman presented with substernal chest pain following a motor vehicle accident. During her evaluation, she was found to have positive results for cardiac enzymes and underwent left heart cardiac catheterization. The results of the catheterization demonstrated no significant coronary stenosis. However, her ventriculogram showed basal and anterior akinesis.Case 2: A 62-year-old Caucasian woman began having substernal chest pain that radiated to her shoulder blades. She was taken to a local area hospital where she was found to have elevated troponins. A left heart catheterization showed an ejection fraction of 35% with hypokinesis of the anterior and posterobasal walls of her heart, with 30% stenosis of her left anterior descending artery but no other significant coronary artery stenosis.ConclusionThe cases in this report illustrate a lesser-known variant of takotsubo cardiomyopathy.

Intrathecal Clonidine Pump Failure Causing Acute Withdrawal Syndrome With ‘Stress-Induced’ Cardiomyopathy

“…In particular, our patient met criteria indicative of takotsubo-type cardiomyopathy [17,18]. He had an acute stress with catecholamine surge, his ECG showed non-specific ST-segment changes, there was a slight elevation in cardiac markers, there were no significant coronary lesions, echocardiogram had a characteristic appearance of the reverse takotsubo pattern, with hypokinesis of all segments except for vigorous contractions of the apex and mid-to apical septum consistent with a 'reverse takotsubo cardiomyopathy' [19] and he had a complete recovery of his cardiac function.…”

The three faces of takotsubo cardiomyopathy in a single patient

“…While two variants of takotsubo (TC) occurring in the same patient has been previously reported, 4,5 three variants in the same patient have not been described. Furthermore, the relatively short timeframe (weeks) seen between variants in our case contrasts with the longer timeframe (years to decades) reported in the literature.…”

Reverse Takotsubo Cardiomyopathy following Exogenous Epinephrine Administration in the Early Postpartum Period

“…Patients with the reverse variant tend to have a less symptomatic course than classic TCM. It is thought that left ventricular basal hyperkinesis in apical TCM can cause LVOT obstruction and lead to hemodynamic compromise, whereas the basal ballooning prevents this in reverse TCM …”