Recurrent Takotsubo Syndrome Presenting with Different Ballooning Patterns and Electrocardiographic Abnormalities

Area of Science:

• Cardiology
• Cardiomyopathy
• Stress-induced cardiomyopathy

Background:

• Takotsubo syndrome (TS), also known as stress-induced cardiomyopathy, is characterized by transient left ventricular dysfunction.
• Recurrence of TS is documented, but changes in ballooning patterns and electrocardiographic (ECG) abnormalities during recurrence are less common.

Approach:

• This report details a rare case of recurrent Takotsubo syndrome in a 73-year-old woman.
• The patient initially presented with apical ballooning pattern TS and later experienced a second episode with mid-ventricular ballooning.
• Electrocardiogram (ECG) findings differed between the two episodes, alongside the change in ventricular morphology.

Key Points:

• The patient experienced recurrent Takotsubo syndrome two years after the initial event.
• The second episode presented with a different left ventricular ballooning pattern (mid-ventricular) compared to the first (apical).
• Distinct electrocardiographic abnormalities were observed in each episode, underscoring the variability in recurrent TS.

Conclusions:

• Recurrent Takotsubo syndrome can manifest with diverse morphological and functional changes.
• This case underscores the importance of considering varied presentations in recurrent stress-induced cardiomyopathy.
• Further research into the mechanisms underlying pattern variation in recurrent TS is warranted.