Short-term recurrence of takotsubo syndrome with phenotypic variation: a case report

Abstract

Background Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome characterised as an uncommon left ventricular (LV) cardiomyopathy. Recurrence of TTS is rare, estimated to be 1-6%. We report a rare case of TTS that occurred three times in two months but manifested various phenotypes. Case summary A 68-year-old woman was admitted to our hospital with acute-onset chest pain and hypertension. The coronary angiography findings were normal, although left ventriculography (LVG) revealed inferior wall hypokinesis, leading to a mid-ventricular TTS diagnosis. She was discharged on day 3 after her symptoms improved and vitals stabilised. The patient’s condition remained uneventful until two weeks post discharge, when acute chest pain and hypertension recurred. She was admitted again with the same diagnosis. However, LV morphology revealed an apical ballooning pattern, with inferior LV wall hypokinesis. She was discharged on day 7 after her symptoms and electrocardiography findings improved but was readmitted again two weeks later after acute chest pain and hypertension recurred. LVG performed a third time demonstrated mid-ventricular TTS. The patient was prescribed additional medications and discharged on day 12. Her electrocardiography findings normalised, and the patient remained asymptomatic without recurrence four months after the initial presentation. Discussion Recurrence and phenotypic change of TTS is rare. Some cases have been reported but occurring months to years after initial diagnosis. Combined treatment with β-blockers and angiotensin converting enzyme inhibitors or angiotensin receptor antagonists may be more effective to prevent the recurrence than monotherapies.