A Rare Case of Takotsubo Cardiomyopathy Recurrence With Alternate Reverse Phenotypes

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Takotsubo cardiomyopathy (TCM) is a stress-induced heart condition with transient left ventricular dysfunction.
• Atypical variants like reverse TCM are uncommon, presenting with basal/mid-ventricular akinesis and apical sparing.
• Recurrent TCM and phenotypic switching between variants are exceedingly rare.

Purpose of the Study:

• To report a rare case of recurrent Takotsubo cardiomyopathy (TCM) with phenotypic switching.
• To emphasize the diagnostic and clinical management challenges posed by atypical TCM variants and recurrence.
• To highlight the importance of recognizing phenotypic switching in patients with recurrent cardiac abnormalities.

Main Methods:

• Case report of a 61-year-old woman with a history of apical TCM.
• Clinical presentation with epigastric pain, nausea, and vomiting.
• Diagnostic workup including laboratory tests, ECG, and echocardiography.

Main Results:

• Echocardiogram revealed basal-to-mid left-ventricular hypokinesis with apical sparing (LV ejection fraction 40%), consistent with reverse TCM.
• The patient had a history of apical TCM diagnosed a year prior, indicating recurrent disease.
• This represents a rare case of phenotypic switching between apical and reverse TCM variants.

Conclusions:

• TCM exhibits significant heterogeneity in presentation, necessitating recognition of atypical variants.
• Phenotypic switching in recurrent TCM, though rare, should be considered in patients with troponin elevation and unusual wall-motion abnormalities.
• Comprehensive clinical assessment and cardiac imaging are crucial for diagnosing and managing recurrent TCM with variant switching.