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Internal Medicine

Training Level

Resident PGY 2


Henry Ford Hospital


Introduction: Takostubo Cardiomyopathy (TCM) is a unique condition of reversible cardiac dysfunction precipitated by emotional or physical stress. Studies are emerging noting an association with Amyotrophic Lateral Sclerosis (ALS). This is hypothesized to be secondary to baseline elevation of catecholamines in these individuals.

Case Presentation: A 53-year-old female with background of anxiety, presented with acute onset chest pain. Initial evaluation revealed elevated troponins without ST changes on EKG. Echocardiogram showed EF 28% with apical ballooning and left heart catheterization was unremarkable. Her echocardiogram improved 2 weeks later, consistent with TCM. During this evaluation it was noted she was significantly dysarthric. On further history she revealed progressive odynophagia for the past year, generalized muscle weakness for the past few months, and dysarthria for 4-6 weeks. Neurological exam demonstrated both upper and lower motor neuron findings of diffuse muscle atrophy, fasciculations as well as brisk peripheral reflexes, jaw jerk and bilateral Hoffmans. MRI brain/spine imaging showed no significant abnormalities and EMG indicated lower motor neuron changes. CPK, anti-MUSK, anti-acetylcholine receptor antibodies were normal and extensive evaluation of paraneoplastic, vitamin and autoimmune disease were negative. An ALS diagnosis was made. Due to worsening respiratory status she required intubation with subsequent tracheostomy placement and ultimately was discharged to a long-term care facility.

Conclusion: This case highlights the uncommon association of TCM in ALS with a unique scenario where it was the presenting feature of the disease. Physicians should be vigilant for neurological symptoms in patients presenting with chest discomfort or risk missing the diagnosis.

Presentation Date


Broken Heart, Broken Mind