A Case of Recurrent Takotsubo Cardiomyopathy: Not a Benign Entity

Abstract

Takotsubo cardiomyopathy is a relatively uncommon condition triggered by severe physical and/or emotional stress. It is characterized by transient ventricular wall dysfunction in the absence of coronary artery disease (CAD). Herein, we report a case of a 59-year-old female who had three episodes of recurrent Takotsubo cardiomyopathy. On each occasion, she presented with symptoms of acute coronary syndrome accompanied by left ventricular wall motion abnormalities; however, repeat cardiac catheterization failed to show CAD. Each recurrence resulted in resolution of her symptoms and recovery of left ventricular function. While emotional triggers were identified, on two occasions, the patient presented with ventricular fibrillation for which an implantable cardioverter defibrillator (ICD) was ultimately placed. We encourage clinicians to no longer look at Takotsubo cardiomyopathy as a benign, reversible disease process, but rather as a pathological entity with real, life-threatening complications that may be managed with ICD placement.

Electrocardiographic Abnormalities in a Woman in Her 70s With Syncope

“…The sinus node is a crescent-shaped cluster of myocytes, approximately 1 to 2 cm long, located in the high right atrium near the junction of the crista terminalis and the superior vena cava . The sinus node is composed of pacemaker (P) cells, which are responsible for impulse formation, and perinodal or transitional cells, which transmit the impulse to the surrounding atrial tissue, resulting in myocardial depolarization . Sinus node dysfunction was first described in 1968 and encompasses a wide array of abnormalities, including persistent sinus bradycardia, chronotropic incompetence, SA exit block, and sinus arrest.…”

“…In the present case, ECG captured by telemetry showed SA block and sinus arrest. Sinoatrial block is caused by problems in transmission of impulses from the sinus node to the surrounding atrial myocardium and is thought to be related to abnormalities in transitional cells . Because its mass is too small to create a detectable signal on surface ECG, sinus node activity can be inferred only indirectly by the presence or absence of P waves that, based on their axis, reflect atrial myocardial depolarization propagating from the area of the sinus node.…”