Forme Fruste in Recurring Mid-Ventricular Variant of Takotsubo Cardiomyopathy

Abstract

Patient: Female, 69 Final Diagnosis: Mid ventricular type of Takotsubo cardiomyopathy Symptoms: Chest discomfort Medication: — Clinical Procedure: Angiography • 2D echocardiogram Specialty: Cardiology Objective: Unusual clinical course Background: Takotsubo cardiomyopathy (TC) is characterized as acute left ventricular dysfunction precipitated by intense emotional or physiological stress. The mid-ventricular variant of TC usually has akinesis, with or without ballooning of the mid-ventricular segment, and a hyperdynamic base and apex. Recurrence of the typical and atypical (reversed and mid-ventricular type) forms has been reported in only a very small number of cases. We report a forme fruste presentation of mid-ventricular variant of TC. Case Report: A 69-year-old woman with a prior history of stress-induced cardiomyopathy presented with complaint of moderate intensity, persistent, sub-sternal chest discomfort. She reported that her symptoms were similar to those she had during a previous hospitalization in 2015, and this time cited the death of her mother as an inciting stressor. No significant obstructive flow-limiting coronary artery disease was found on cardiac catheterization. However, the left ventriculogram was suggestive of mid-ventricular pattern of TC. Her first symptomatic episode of apparent TC did not reveal completion of the mid-ventricular pattern of the TC variant. The subsequent episode, during this hospitalization, manifested as a completed version of her initial apparent forme fruste of mid-ventricular variant of TC. Conclusions: TC may present in a myriad of clinical forms that must be considered in the evaluation of patients with suspected acute coronary syndromes or cardiomyopathy. Treatment is mainly supportive, and recurrence rates range from 7.7% to 11.4%. To the best of our knowledge, this forme fruste presentation has not been previously reported in recurrent variants of TC.

Serious takotsubo cardiomyopathy: an autopsy case presenting severe irreversible myocardial damage after frequent episodes of recurrence

“…New electrocardiographic abnormalities, such as ST-segment elevation or elevation in cardiac troponin are observed. Reported recurrence rates range from 0 to 15% [4][5][6][7][8]. Although a few papers reported that the earliest time of recurrence was 8 days [4,6], in most cases, a relapse occurs within a few months or years [1,4,6,[9][10][11][12][13].…”