A Case of Recurrent Takotsubo Cardiomyopathy

Introduction Takotsubo cardiomyopathy (TCM), stress cardiomyopathy, broken heart syndrome, or transient left ventricular apical ballooning syndrome has an uncertain prevalence. It typically occurs in post-menopausal women and may account for up to 2.5% of all patients with acute coronary syndrome (ACS) symptoms (2, 5-7). Although a small fraction of patients have no identifiable trigger, TCM is most commonly preceded by an emotional or physical stressor (1, 2, 6, 7). The most common presenting symptom of TCM is chest pain, followed by dyspnea (5, 6, 7). Patients often have electrocardiogram (ECG) abnormalities that are large in magnitude, most commonly ST segment elevations in the precordial leads and T wave inversions (1, 6, 7). Elevated cardiac enzymes are also a common feature, occurring in 86.2% of cases. (1, 6). On echocardiogram TCM typically presents with marked left ventricular dysfunction that is in a greater distribution than that of a single coronary vessel, however cardiac catheterization typically show normal coronary vessels. (1, 2, 5, 6). What further characterizes TCM is the recovery of EF within days to weeks, with an average EF at follow-up ranging from 60-76% (1,6). The treatment for TCM is largely supportive and recurrence is rare. Here we present a unique case of recurrent TCM with variable presentation whose initial episode was treated to resolution with the current-day standard of treatment.