Takotsubo syndrome presenting with high-degree atrioventricular block with ventricular asystole

Takotsubo syndrome (TS) is a reversible form of cardiomyopathy characterized by transient systolic dysfunction with regional wall motion abnormalities and absence of coronary artery obstruction, which can be precipitated by severe emotional or physical stress. Its clinical presentation is similar to that of acute coronary syndrome. However, TS presenting with atrioventricular (AV) block with ventricular asystole is rarely reported. In this article, we describe the case of a postmenopausal woman who experienced near cardiac arrest due to high-degree AV block. Although transthoracic echocardiography revealed left ventricular dysfunction with severe global hypokinesia, coronary angiography and cardiac magnetic resonance imaging showed normal coronary arteries without myocardial scarring. The patient's condition improved after permanent pacemaker implantation and medical treatment for heart failure. Echocardiography and pacemaker analysis at two-month follow-up revealed normalization of heart function and cardiac rhythm, and the patient was finally diagnosed with TS. <Learning objective: Takotsubo syndrome can present with conduction abnormalities such as a high-degree atrioventricular block in case of left ventricular basal segment involvement. Cardiac magnetic resonance imaging is useful for distinguishing stress-induced cardiomyopathy from other myocardial diseases with non-obstructive coronary arteries.>.