Sequential transition of mid-basilar variant to apical form of Takotsubo syndrome

Takotsubo syndrome, also called apical ballooning syndrome, is a clinical entity characterized by transient hypokinesis, akinesis, or dyskinesis of the left ventricular mid and apical segments without flow limiting obstructive coronary lesions. There have been many reported morphologic variants of apical ballooning syndrome based upon distribution of segment involvement including traditional apical, midventricular, and basilar. We present a patient who demonstrated sequential transition of mid-basilar type to classical apical ballooning type. <Learning objective: Takotsubo syndrome mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. Many morphological presentations can present, hence increased awareness may help practitioners identify and properly treat this condition. This is the first reported case of a sequential transition between variants.>.