Reverse Takotsubo Cardiomyopathy Mimicking ST-Elevation Myocardial Infarction in a Postpartum Woman

Takotsubo cardiomyopathy, also known as Gebrochenes-Herz syndrome, transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, or broken heart syndrome, is a rare disease triggered by stressful events, such as a high plasma concentration of catecholamines and their metabolites, which resembles acute coronary syndrome. It is characterized by transient regional systolic dysfunction of the left ventricle mimicking acute myocardial infarction. The term Takotsubo originates from the Japanese word for an "octopus trap," which resembles the shape of the ventricle during systole. A 28-year-old woman in the early postpartum period presented to the emergency department with a sudden onset retrosternal chest pain and shortness of breath. At first, electrocardiography and laboratory evaluation workups suggested acute coronary syndrome. Transthoracic echocardiography revealed hypokinesia of the basal and mid left ventricular segments with preserved apical contractility, resulting in a left ventricular ejection fraction of 35%. The patient underwent immediate coronary angiography, which showed normal coronary arteries as well as no obstructive disease. Follow-up echocardiography showed recovery of left ventricular function with an improvement of the left ventricular ejection fraction to 55%, consistent with a diagnosis of reverse Takotsubo cardiomyopathy, occurring in the postpartum period which is an important STEMI mimic. Takotsubo cardiomyopathy is an important differential diagnosis in postpartum women presenting with acute coronary syndrome-like symptoms and requires careful multimodal evaluation to distinguish it from peripartum cardiomyopathy and myocarditis. The patient stabilized following supportive management, with complete recovery of left ventricular function.