One Patient: Two Variants of Takotsubo Cardiomyopathy.

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Takotsubo cardiomyopathy (TCM) is a stress-induced, transient left ventricular dysfunction mimicking acute coronary syndrome.
• It typically presents with a single anatomical variant, characterized by apical ballooning on echocardiography.

Observation:

• A 32-year-old woman with a history of alcohol use disorder, anxiety, and hypertension presented with symptoms of heart failure and cardiogenic shock.
• Initial echocardiogram revealed typical apical TCM with reduced ejection fraction.
• Four months later, she experienced a recurrence with symptoms of heart failure, but echocardiography showed reverse TCM.

Findings:

• This case highlights a rare instance of TCM recurrence in a single patient with two different anatomical variants (typical apical and reverse).
• Recurrence of TCM typically involves the same anatomical variant, making this case unusual and poorly understood.

Implications:

• This case underscores the need for further research into the predictors of TCM recurrence and the underlying mechanisms driving different anatomical variants.
• Understanding these factors is crucial for managing patients with recurrent TCM and varying presentations.