Takotsubo Cardiomyopathy presenting with different morphological patterns in the same patient: a case report and review of the literature.

Background: Takotsubo Cardiomyopathy is characterized by transient left ventricular systolic dysfunction, which often mimics a myocardial infarction and is usually triggered by emotional or physical stress. There are four variants of Takotsubo Cardiomyopathy, based on the affected left ventricular area.

Methods: We report a 75-year-old female with a past medical history of diabetes mellitus, hypertension, hyperlipidemia, and chronic kidney disease who presented with chest pain that had started after a stressful, emotional event. Her electrocardiogram showed no ischemic changes, troponin was mildly elevated, and cardiac catheterization revealed nonobstructive coronary artery disease. Echocardiogram showed a decreased ejection fraction and apical akinesia with basal hyperkinesia consistent with classical Takotsubo Cardiomyopathy. The patient symptomatically improved on optimal heart failure therapy, and a follow-up echocardiogram showed improvement in her systolic function. Over a year later, the patient was readmitted with chest pain, which also began after an emotional event. ECG showed nonspecific ST-T wave changes, and troponin was mildly elevated. Echocardiogram demonstrated a reduced ejection fraction and inferior akinesia with apical hyperkinesia consistent with reverse Takotsubo Cardiomyopathy. A repeat cardiac catheterization exhibited mild nonobstructive coronary artery disease unchanged from her previous report. A follow-up echocardiogram showed full recovery of her systolic function.

Conclusions: Classical and reverse Takotsubo Cardiomyopathy due to different stressors have been reported in the literature individually, but up to our knowledge, both variants of Takotsubo Cardiomyopathy occurring in the same patient has not been reported previously.