A case report of recurrent takotsubo cardiomyopathy including the rare ‘inverted’ form

Abstract

Background Takotsubo cardiomyopathy (TC) is a disease that causes transient left ventricular (LV) dysfunction in multiple vascular territories in the absence of coronary artery disease. Takotsubo cardiomyopathy is typically associated with dilation and dyskinesia of the apical and mid-LV segments induced by acute emotional and/or physical stress. Here, we present a case of recurrent TC including one episode of inverted TC, which is a rare form where dyskinesia occurs in the basal segments with sparing of the apical segments. Case summary A 53-year-old female patient with a background history of chronic stress and anxiety was admitted with three episodes of recurrent TC over 4 years. The first episode in 2017 was triggered by an acute stressful event, but no major triggers were identified for the subsequent episodes. Although the first and third episodes displayed the signs of classical TC, the second episode was an inverted TC. Full cardiac function was restored after each episode. She now takes prognostic heart failure medications long term and mental health teams are trying to support her emotional wellbeing. Discussion This patient displayed a rare disease course involving three recurrent episodes of TC, including one instance of its inverted form. Although psychiatric conditions and emotional stress are acknowledged as risk factors for TC, further research is needed to assess whether mental health treatment following TC can prevent disease recurrence.

The Swiss cheese model in takotsubo syndrome

“…describe the case of a woman experiencing multiple TTS recurrences, the second one presenting with the uncommon basal contraction pattern, providing an insightful diagnostic confirmation by means of cardiac magnetic resonance tissue mapping imaging. 10 Consistently with registry data, the patient had several comorbidities including previous meningioma excision, hypertension and irritable bowel syndrome; of note, her clinical history included chronically high levels of emotional stress and anxiety, with emotional distress preceding at least the first event. The Journal recently published two more case reports that could meet this same clinical picture, with multiple TTS recurrences affecting women and preceded, when identifiable, by a trigger of emotional nature.…”