Lesser Severity of Recurrent Takotsubo Cardiomyopathy While Taking Angiotensin II Receptor Blocker and Beta Blocker

Abstract

Takotsubo cardiomyopathy (TC) is characterized by transient systolic and diastolic dysfunction, ventricular wall motion abnormalities and troponin elevation. The most common presenting symptoms are acute chest pain and dyspnea. The etiology is unknown but believed to be related to a surge in catecholamines as it is commonly associated with a preceding physical or emotional stress. Due to the lack of specific treatment, recurrence occurs in 2-12% of patients per year. We present a case of a patient with TC subsequently treated with an angiotensin II receptor blocker (ARB) and beta-adrenergic blocker (beta-blocker). A repeat TC episode 4 months later showed less severely abnormal cardiac enzymes, echocardiogram and overall hospital course. Because our patient experienced a classic episode of TC and a recurrent episode with milder symptoms and lower troponins, we hypothesize her medication regimen was a contributing factor to the milder manifestation of this cardiac syndrome.