Recurrent Takotsubo Cardiomyopathy Secondary to Cyclical Vomiting Syndrome

We present a case of a young woman having recurrent admissions secondary to cyclical vomiting syndrome complicated with stress-induced cardiomyopathy/takotsubo cardiomyopathy (TC). She not only had left ventricular dysfunction but also suffered from anxiety and post-traumatic stress disorder for which professional help was sought. TC is defined as reversible, transient ventricular dysfunction in the absence of coronary artery disease. Due to the similarity of TC to acute coronary syndrome, TC is often left as a diagnosis of exclusion as it relies heavily on diagnosis by history, physical examination, and ultrasound imaging. Extreme emotional or physical stress can act as a trigger and timely identification and management of triggers causing TC are important to improve the outcome. In addition to physiological impact, TC also puts a toll on psychological health. Although the mechanism is not completely understood, reportedly plasma levels of epinephrine and norepinephrine were significantly elevated in patients with TC which might contribute to depression, anxiety, and psychological distress. Along with proper medical care, psychological care is equally important for patients with TC.