Atypical stress-induced cardiomyopathy: a case series

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Clinical Case Studies

Background:

• Stress-induced cardiomyopathy (SIC), also known as Takotsubo cardiomyopathy, involves transient left ventricular (LV) systolic dysfunction.
• It is typically triggered by acute emotional or physical stress in the absence of obstructive coronary artery disease.
• Classic presentation includes apical and/or mid-ventricular wall motion abnormalities (WMA), minimal troponin elevation, and ECG changes.

Purpose of the Study:

• To describe three cases of stress-induced cardiomyopathy exhibiting atypical patterns of left ventricular wall motion abnormalities.
• To discuss potential pathogenetic mechanisms contributing to the observed variability in WMA distribution in SIC.

Main Methods:

• Case series review of three patients diagnosed with stress-induced cardiomyopathy.
• Analysis of echocardiographic findings to characterize the distribution of left ventricular wall motion abnormalities.
• Review of clinical presentation, laboratory results (troponin), and ECG findings.

Main Results:

• All three patients presented with stress-induced cardiomyopathy but showed atypical WMA patterns, deviating from the typical apical or mid-ventricular involvement.
• The distribution of WMA varied among the cases, suggesting heterogeneity in the myocardial response to stress.
• Troponin levels and ECG changes were consistent with SIC, despite the unusual WMA.

Conclusions:

• Stress-induced cardiomyopathy can manifest with diverse and atypical patterns of left ventricular wall motion abnormalities.
• The variability in WMA distribution may be influenced by complex pathogenetic mechanisms that warrant further investigation.
• Recognizing atypical presentations is crucial for accurate diagnosis and management of SIC.