Takotsubo cardiomyopathy case series: typical, atypical and recurrence

Takotsubo cardiomyopathy (TCM) is characterised by a transient left ventricular (LV) dysfunction, ECG changes that can imitate acute myocardial infarction and positive cardiac biomarkers in the absence of obstructive coronary artery disease. The exact pathogenesis of TCM is unclear but emotional or physical stress is a common denominator. We present three cases encompassing a spectrum of the disease: A typical TCM with apical LV dyskinesis, an atypical TCM with mid-ventricular regions affected and a TCM recurrence. Our cases show that TCM symptoms vary between individuals and may vary in the same patient. All our patients reported acute emotional stress prior to the onset of symptoms, had LV systolic dysfunction, positive cardiac biomarkers and non-obstructed coronary arteries. In all cases, LV systolic dysfunction eventually improved. TCM may account for 0.7-2.5% of acute coronary syndromes. It is more prevalent in the female population and can reoccur. Treatment is mainly supportive.