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An Emotional Stress as a Trigger for Reverse Takotsubo Cardiomyopathy: A Case Report and Literature Review

Unusual clinical course, Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Aram Barbaryan, Stefania L Bailuc, Krishan Patel, Muhammad Wajih Raqeem, Atul Thakur, Aibek E. Mirrakhimov

Department of Internal Medicine, Hospital Sisters Health System – St. Mary’s Hospital, Decatur, IL, USA

Am J Case Rep 2016; 17:137-142

DOI: 10.12659/AJCR.896549

Available online:

Published: 2016-03-06

BACKGROUND: Reverse Takotsubo cardiomyopathy is one of the rarest types of stress-induced cardiomyopathy, which despite sharing similar pathogenic mechanisms with its more common counterpart, has different clinical manifestations, demographics, and laboratory values.
CASE REPORT: We present the case of a 61-year-old woman who came to the hospital with a chief complaint of chest pain and dyspnea. She was found to have elevated troponin and severely depressed left ventricular function. Echocardiography showed normal contracting apex, with the rest of the left ventricle being hypokinetic. Cardiac catheterization revealed mild coronary artery disease and confirmed echocardiographic findings showing hyperkinetic apex and dilated base. She was discharged home on ACE inhibitor and B-blocker. A repeat echocardiogram 2 weeks after the initial presentation showed complete resolution of cardiac dysfunction.
CONCLUSIONS: Reverse Takotsubo cardiomyopathy is a rare disease mimicking acute coronary syndrome. It is essential to rule out organic coronary disease prior to attributing the presentation to Takotsubo cardiomyopathy. With supportive care, the long-term prognosis is good in the vast majority of patients.

Keywords: Chest Pain - etiology, Acute Coronary Syndrome - diagnosis, Diagnosis, Differential, Dyspnea - etiology, Female, Humans, Middle Aged, Stress, Psychological - complications, Takotsubo Cardiomyopathy - etiology