Over the Exceptions: Psychiatric Disorder, Medical Stress, and Takotsubo Cardiomyopathy

Exact natural history and physiopathology of takotsubo cardiomyopathy (TC) are incompletely understood. In the last years, a lot of special cases of TC appeared in the literature. This case report is a typical case of TC, which meets all Mayo Clinic diagnosis criteria, over the exceptions; its main feature is that it has both physical (medical) and emotional (psychiatric) triggers. The protagonist is a woman affected by anxious-depressive syndrome, hospitalized for a cardiogenic syncope. After pacemaker (PMK) implantation, she first has convulsive hysteric crisis, and the following day, she has a transient left ventricular apical ballooning without coronary artery stenosis: takotsubo syndrome. This case underlines the depth and strong relationship between takotsubo syndrome and psychiatric illness, which is both clinical substrate and triggering acute event, with the significant role of PMK implantation which might have had a role both as flare of psychiatric disease and as a trigger for the syndrome itself.