NEVER ENDING SAGA OF TAKOTSUBO CARDIOMYOPATHY RECURRENCES

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

catecholamine, troponin, adult, aged, akinesia, case report, clinical article, complication, conference abstract, coronary angiography, coronary artery spasm, drug therapy, dyspnea, echocardiograph, echocardiography, electrocardiography, female, follow up, human, hyperkinesia, hypertension, hypokinesia, nausea, physical stress, recurrence risk, recurrent disease, Takotsubo cardiomyopathy, very elderly

Abstract

Background: Takotsubo cardiomyopathy (TC) is an acute, transient left ventricular (LV) dysfunction triggered by emotional or physical stress. While most recover quickly, recurrence occurs in 2%-4%. Here, we describe multiple recurrences of TC with different echocardiographic patterns. Case A 67-year-old woman with a history of hypertension (HTN) and non-obstructive CAD, first presented with uncontrolled HTN, dyspnea, nausea, and flushing. Workup showed elevated troponin levels, normal EKG, and an echocardiogram showing reduced EF of 2025% with apical akinesis. Coronary angiography confirmed no significant CAD, and a left ventriculogram revealed Takotsubo pattern with apical akinesis and basal hyperkinesis. On follow-up, her symptoms completely resolved, and a repeat echocardiogram normalized. She presented three years later with similar symptoms. Echocardiogram showed an EF of 51%, new severe MR, with basal septal and inferior wall hypokinesis with apical hyperkinesis, pattern consistent with reverse TC. She responded well to medical therapy, with resolution of the wall motion abnormalities. Since then, she has experienced three additional episodes, with evidence of recurrence of both typical and reverse Takotsubo patterns. Extensive workup has been negative for secondary causes of HTN. She remains asymptomatic between episodes with no clear triggers for her recurrent presentations. Decision-making TC is a reversible stress-induced cardiomyopathy characterized by LV dysfunction involving apical or periapical walls. A variant, reverse TC, is less common, accounting for fewer than 20% of cases and involves basal and inferior wall hypokinesis with apical hyperkinesis. Potential causes include catecholamine surge, microvascular dysfunction, or coronary spasm. Management focuses on supportive care, GDMT, and monitoring for complications such as shock and ventricular thrombi. Conclusion Our patient experienced five episodes of TC over a six-year period, which is an unusually high recurrence rate. Contrary to prior literature of benign outcomes, our case reiterates that a subset of TC patients suffer from ongoing morbidity and should be followed closely long term.

Volume

85

Issue

12

First Page

3146

Find It @ Sladen

Share

COinS