Role of speckle-tracking echocardiography in diagnosing reverse Takotsubo syndrome in the intensive care unit

Takotsubo cardiomyopathy (TCM), often referred to as broken heart syndrome, presents as a temporary dysfunction of the heart's left ventricle (LV) apex, resembling a heart attack but without any blockage in the coronary arteries. Reverse TCM, a less common variant, is characterized by abnormal heart muscle contractions primarily affecting the basal and midventricular segments. We report a case of a 76-year-old patient undergoing hip surgery who developed reverse TCM, diagnosed through echocardiography with speckle tracking in the intensive care unit (ICU). Intraoperatively, the patient experienced shock necessitating ICU admission and mechanical ventilation. Point-of-care ultrasound revealed bilateral B-lines compatible with pulmonary edema and severe deterioration of LV function. Speckle-tracking echocardiography (STE) demonstrated a LV global longitudinal strain (GLS) of - 11% with an abnormal bull's eye pattern consistent with reverse TCM. Subsequent coronary angiography ruled out ischemic cardiomyopathy. Inotropic support improved the patient's condition, with subsequent lung ultrasound demonstrating normal aeration. Follow-up echocardiography exhibited improved cardiac function, with the speckle-tracking mode showing improvement in the bull's eye pattern and GLS. Reverse TCM, although rare, can occur in postoperative settings and necessitates prompt diagnosis and management. STE holds promise as a valuable tool for its detection and monitoring, particularly in critical care settings.