Takotsubo Syndrome and Arrhythmias: The Chicken and Egg Dilemma

Takotsubo syndrome (TTS), also known as broken heart syndrome, is a transient and reversible cardiomyopathy characterized by left ventricular dysfunction in the absence of obstructive coronary artery disease. Although often considered benign, TTS can lead to serious arrhythmic complications such as atrioventricular block (AVB) and life-threatening ventricular arrhythmias. We present the case of a 74-year-old woman with cardiovascular risk factors who developed complete AVB and torsades de pointes during the course of a TTS episode. The diagnosis was based on clinical presentation and imaging findings, including recovery of left ventricular ejection fraction. Cardiac magnetic resonance imaging was limited by technical constraints but supported the diagnosis. This case highlights the complex arrhythmic manifestations that may accompany TTS and underscores the importance of careful rhythm monitoring and device selection. Implantable cardioverter-defibrillator therapy was ultimately chosen due to the occurrence of sustained ventricular arrhythmias. Clinicians should be aware that TTS, though reversible, may present with conduction disturbances and ventricular arrhythmias requiring aggressive management and appropriate device implantation strategies.