DIFFERENT FACES OF TAKOTSUBO CARDIOMYOPATHY WITH TRIPLE OCCURRENCE IN A PATIENT

Document Type

Conference Proceeding

Publication Date

3-7-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: We present a case of triple occurrence of Takotsubo Cardiomyopathy (TCM) to highlight 2 key features: 1. Although uncommon, TCM can be recurrent 2. Multiple variations of TCM can present in the same patient.

Case: A 64 year old female presented with acute shortness of breath, cough, and orthopnea. Physical examination was notable for coarse crackles throughout both lungs, a holosystolic murmur at the apex, and bilateral lower extremity edema. Labs showed elevated high sensitivity troponin with a peak of 3000 with normal EKG. Transthoracic echocardiogram (TTE) demonstrated an ejection fraction of 51%, new severe mitral regurgitation (MR), hypokinesis of the basal and inferior wall as well as hyperkinesis of the apical wall. Diagnostic catheterization was negative. She was diagnosed with reverse Takotsubo Cardiomyopathy (rTCM) and managed with aggressive diuresis, afterload reduction, and goal directed medical therapy. One week after hospitalization, repeat TTE demonstrated resolution of all wall motion abnormalities, marked improvement of mitral regurgitation and normalization of left ventricle function. She was readmitted 2 months later with acute heart failure and diagnosed with recurrent TCM, her third occurrence of Takotsubo Cardiomyopathy.

Decision-making: TCM has similar presentation to acute coronary syndrome (ACS) but without angiographic evidence of obstructive coronary disease. As such, an essential feature of TCM or its variants is to first rule out ACS in these patients. Her history of TCM assisted in diagnosis as she carried a risk of recurrent TCM. Severe MR in this case was likely due to involvement of basal LV segments with resolution of MR on follow-up echo and no recurrence of MR with the third episode.

Conclusion: Recurrent TCM can happen in up to 4% of cases, with 20% being TCM variants. rTCM is an uncommon variant of TCM and presents similarly to acute coronary syndrome. Basal hypokinesis/akinesis with or without apical hyperkinesis will be seen on TTE. Treatment is largely supportive. We describe a dramatic case of triple recurrence of TCM which is extremely rare.

Volume

81

Issue

8

First Page

3829

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