Reverse takotsubo cardiomyopathy followed by left ventricle outflow tract obstruction: A dangerous relay race

Reverse takotsubo cardiomyopathy (rTTC) is a less frequent variant of takotsubo cardiomyopathy (TTC) with several differences about epidemiology and clinical aspects. While left ventricular outflow tract (LVOT) obstruction is relatively frequent in TTC patients, this complication has not been reported in the setting of rTTC yet. We describe the case of a female patient with rTTC complicated by LVOT obstruction and systolic anterior motion of mitral valve: the onset of these findings coincided with the regression of wall motion abnormalities. This dangerous "relay race" seems to be not casual but related to the characteristics of rTTC and should be always expected and prevented. <Learning objective: Left ventricle outflow tract obstruction with systolic anterior motion of mitral valve is an insidious complication that may be associated with reverse takotsubo cardiomyopathy and not only with the classic takotsubo cardiomyopathy. This complication appears to be delayed and should be always expected. Close echocardiographic monitoring, careful fluid support and early start of beta-blocker therapy may prevent it.>.