Atypical form of Takotsubo cardiomyopathy.

To cite: Jouhra F, Dworakowski R, MacCarthy P. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2012008376 DESCRIPTION A 60-year-old lady was referred to our cardiology team with troponin-positive chest pain following elective pelvic floor repair for vaginal prolapse. There were no significant ECG changes. Cardiovascular risk factors consisted of extensive history of smoking, positive family history and hyperlipidaemia. She suffered from depression and fibromyalgia. The patient exhibited normal preoperative transthoracic echocardiogram. However, transthoracic echocardiogram after the episode of chest pain showed septal, anteroseptal, anterior, inferior and posterior hypokinesis with preserved apical function and no apical ballooning. A coronary angiogram revealed unobstructed arteries. Subsequently, the patient underwent cardiac MRI which confirmed these findings and showed moderately impaired function with hypokinesia of all mid-left ventricular segments (figure 1A,B and videos 1 and 2). The apical and basal segments had relatively preserved systolic function. There was no evidence of scar on late enhancement images (figure 1C and video 3). Subsequently, the patient underwent a repeated cardiac MRI after 3 months which showed resolution of these abnormalities (figure 2A,B and videos 4 and 5). Takotsubo cardiomyopathy is a recognised form of transient left ventricular dysfunction that is presumably caused by emotional, physical or medical stress. It can clinically resemble an acute coronary syndrome. Patients typically present with chest pain or dyspnoea, electrocardiographic changes