Takotsubo cardiomyopathy: A case report

Ajay1, S. Aravinda Kumar2

1DNB Cardiology Resident, Kauvery Heart city Trichy

2Chief consultant interventional cardiologist, Kauvery Heart city Trichy

Background

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, is a reversible cardiac condition characterized by transient left ventricular dysfunction often triggered by emotional or physical stress. This case report details the presentation, diagnostic workup, and management of a 69-year-old female presenting with acute onset chest pain, breathlessness, and suspected Takotsubo cardiomyopathy.

Case Presentation

A 69-year-old female, who was a known to have hypertension, presented with acute onset chest pain for three days along with history of profuse sweating and giddiness, accompanied by dyspnea NYHA Class 4. There was a history of death of her brother 3 days prior to the onset of symptoms.

Her initial ECG revealed normal sinus rhythm with T-wave inversions in leads V5 and V6. Troponin I and CK-MB levels were found to be negative, ruling out acute myocardial infarction. Echocardiography demonstrated hypokinesia in the mid and apical left ventricular (LV) segments, apical ballooning, and preserved basal contraction, severe LV systolic dysfunction with an ejection fraction (EF) of 30%, concentric LV hypertrophy (LVH), mild mitral regurgitation, moderate tricuspid regurgitation, and severe pulmonary arterial hypertension (PAH).

Coronary angiogram was done which did not show evidence of obstructive coronary disease. Given the clinical presentation and echocardiographic findings, the patient was suspected to have apical Takotsubo cardiomyopathy, likely triggered by the recent emotional stress of losing her brother.

ECG and Chest X-ray

Echocardiography

Coronary Angiogram

Discussion

This report on 69-year-old female who presented with acute onset chest pain, dyspnea, and suspected apical Takotsubo cardiomyopathy provides valuable insights into the diagnostic challenges and management approaches for this unique cardiac condition.

The patient’s clinical presentation, including chest pain, dyspnea, and ECG changes with T-wave inversions, raised initial concerns for acute coronary syndrome. However, negative troponin I and CK-MB levels, along with characteristic echocardiographic findings of apical ballooning and severe LV dysfunction with preserved basal contraction, supported the diagnosis of apical Takotsubo cardiomyopathy. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture further supports the diagnosis.

Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction with apical ballooning, typically in the absence of significant obstructive coronary artery disease. Echocardiographic findings of regional wall motion abnormalities, particularly involving the apical and mid-ventricular segments, are hallmark features of Takotsubo cardiomyopathy.

The diagnostic workup for Takotsubo cardiomyopathy often includes cardiac imaging modalities such as echocardiography, cardiac MRI, or left ventriculography to assess the extent of myocardial dysfunction and rule out other structural abnormalities. Laboratory tests, including cardiac biomarkers such as troponin and CK-MB, are crucial in differentiating Takotsubo cardiomyopathy from acute coronary syndrome. The presence of transient ECG changes, such as ST-segment elevation or T-wave inversions, may further support the diagnosis of Takotsubo cardiomyopathy.

The patient’s emotional stress following the recent death of her brother adds a layer of complexity to the case, as psychological factors can play a significant role in triggering Takotsubo cardiomyopathy. Recognizing the interplay between emotional stressors and cardiac dysfunction is crucial in addressing the holistic needs of patients with Takotsubo cardiomyopathy and implementing tailored interventions to promote psychological well-being alongside cardiac recovery.

The patient received treatment aimed at managing her symptoms and addressing potential complications associated with Takotsubo cardiomyopathy. Diuretics were prescribed to alleviate pulmonary congestion, while antiplatelet and anticoagulant therapy helped prevent thrombotic events. Beta adrenergic blocker was added to prevent recurrent episodes of Takotsubo cardiomyopathy. Follow up has been planned after 3 months to reassess the ventricular systolic function by Echocardiography.

Conclusion

In conclusion, this case report of apical Takotsubo cardiomyopathy in a 69-year-old female underscores the importance of a multidisciplinary approach to diagnosis and management. The integration of clinical, imaging, and laboratory findings facilitated the accurate identification of Takotsubo cardiomyopathy as the underlying cause of the patient’s presentation. The tailored treatment plan comprising diuretics, antiplatelets, anticoagulants, and beta blockers aimed to address the hemodynamic instability and optimize cardiac function in the acute setting and prevent recurrence of the disease.

Moving forward, close monitoring and psychological support will be essential in guiding long-term management and preventing recurrent cardiac events. This case highlights the need for individualized care, recognizing the interplay between physical and emotional stressors in the pathophysiology of Takotsubo cardiomyopathy. By addressing both the cardiac and psychological aspects of care, healthcare providers can optimize outcomes and enhance the quality of life for patients affected by this unique cardiac syndrome.

Dr. S. Ajay
DNB Cardiology Resident

Dr S Aravindha kumar

Dr. S. Aravinda Kumar
Chief consultant interventional cardiologist

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