Reverse Takotsubo Cardiomyopathy After Accidental Exposure to an Illicit Substance: A Case Report

Stress-induced (Takotsubo) cardiomyopathy is a clinical syndrome and its incidence has been on the rise. Patients with this syndrome often present with chest pain, dyspnea, or syncope. The findings from a typical cardiac evaluation can make this entity difficult to distinguish from acute myocardial infarction (AMI). A 50-year-old woman presented to the emergency department (ED) with anxiety and palpitations after the accidental ingestion of a sympathomimetic. The patient had consumed coffee that she had brewed in a hotel coffee pot, unaware that a previous guest had placed drug paraphernalia including methamphetamine in the water reservoir of the coffee pot. Her symptoms had started shortly thereafter. In the ED, the patient's workup was remarkable for positive troponin and an echocardiogram demonstrating basilar hypokinesis. The patient's ejection fraction was reduced at 40%. She was admitted to the hospital, where she underwent catheterization, demonstrating normal coronary arteries. She had full clinical recovery at the six-month follow-up. Reverse Takotsubo cardiomyopathy is a rare variant of Takotsubo cardiomyopathy, which presents with basal left ventricular hypokinesis. It is associated with younger age and female gender and has an overall good prognosis. This diagnosis should be considered in patients who are otherwise at low risk for atherosclerotic cardiac disease with known emotional or physical triggers and changes in left ventricular function. Treatment is generally supportive, but a Takotsubo cardiomyopathy diagnosis alters the management of shock and dysrhythmia when known.