A Case of Peripartum Cardiogenic Shock Resulting From Reverse Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular (LV) dysfunction that classically presents as apical ballooning with basal hyperkinesis. A recognized variant, reverse TCM, conversely is characterized by basal and mid-ventricular hypokinesis with apical sparing, often triggered by a catecholamine surge. We present a case of a woman who underwent an emergency cesarean section complicated by the development of cardiogenic shock due to TCM. She had rapid clinical improvement with restoration of systolic function and was ultimately treated with guideline-directed medical therapy with a multidisciplinary team to ensure safety while lactating. In this case, the acute onset of LV systolic dysfunction in the setting of physical stress, wall motion abnormalities in a non-ischemic distribution, and rapid clinical recovery were factors that favored TCM as a diagnosis. The diagnosis of pregnancy-associated TCM is challenging, yet differentiation from other cardiomyopathies is important to guide acute management, as well as prognosis and counseling for subsequent pregnancies.