Another Way to Break Hearts: Reverse Takotsubo Cardiomyopathy

A 34-year-old female was found to be hypoxic shortly after intubation during elective eye surgery. The patient then went into ventricular fibrillation leading to cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after several rounds of cardiopulmonary resuscitation with epinephrine. The patient was immediately taken for cardiac catherization which revealed angiographically normal coronary arteries. A computed tomography angiogram chest showed pulmonary embolism and unclear chronicity. Transthoracic echocardiogram (TTE) showed a reduced ejection fraction of 30%-35% with nearly akinetic basal walls, consistent with reverse Takotsubo cardiomyopathy. The patient was started on anticoagulation and was successfully extubated shortly afterward. Cardiac magnetic resonance imaging (MRI) one week later revealed a recovered left ventricular ejection fraction. Our case demonstrated variants of Takotsubo cardiomyopathy while highlighting the notion that cardiac function can be temporarily compromised by acute physiological stressors.