Possible association of influenza A infection and reverse takotsubo syndrome

We present a case of reverse takotsubo syndrome (rTS) in a 68-year-old woman who presented with acute chest pain and flu-like symptoms. She was found to have elevated troponin and abnormal ECG. Urgent coronary angiogram revealed non-obstructive mild coronary artery disease of the left anterior descending artery. Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. Nasal viral PCR was positive for Influenza A. The diagnosis was confirmed with repeat echocardiogram 2 weeks later revealing resolution of regional wall motion abnormalities. rTS is a type of TS, mimicking acute coronary syndrome. It is seen in younger patients and often occurs with intense emotional and physical stress. Though many triggers have been reported, rTS associated with influenza A has not been previously documented.