Atypical presentation of the broken heart syndrome associated with chronic anxiety

The "broken heart syndrome", or Takotsubo cardiomyopathy, is an acute cause of transient left ventricular systolic dysfunction characterized by abrupt onset of chest symptoms, ECG changes and a mild rise in myocardial enzymes mimicking acute myocardial infarction. This condition is more common in postmenopausal women and is typically preceded by an intense emotional or physical stress or an acute illness. A higher prevalence of anxiety disorders in patients with this syndrome have also been reported recently. Apical ballooning with left ventricular akinesis or dyskinesis of distal one-third to two-thirds of the left ventricle in cardiac catheterization and absence of significant coronary obstruction is this hallmark of this condition. However, various morphologic variants with different ventricular region involvement have been reported including "an atypical variant" where the left ventricular hypokinesia is restricted to the midventricular segment without involvement of the apex. Here we present a case of 56-year-old female with a history of chronic anxiety who presented with retrosternal chest pain after her partner threatened to leave her. Her EKG showed diffuse T-wave changes with prolonged QT intervals. She also had modest elevation of cardiac enzymes.