Beyond Apical Ballooning: A Rare Focal Takotsubo Syndrome Variant Following Interscalene Block-Associated Airway...

Takotsubo syndrome (TTS) is a transient stress-induced cardiomyopathy that typically presents with apical ballooning; focal variants are rare and may closely mimic acute coronary syndromes. We present the case of a 74-year-old woman who developed acute hypoxemic respiratory failure secondary to vocal cord and phrenic nerve paralysis following an interscalene block. During hospitalization, she exhibited isolated troponin elevation without chest pain or electrocardiographic changes. Coronary angiography demonstrated nonobstructive coronary arteries, while ventriculography revealed focal lateral wall hypokinesis consistent with focal TTS. Initial management included full acute coronary syndrome therapy, which was subsequently de-escalated after the diagnosis was established. Acute airway obstruction is an uncommon trigger, underscoring the role of catecholamine-mediated myocardial stunning and the importance of early recognition to avoid unnecessary interventions and guide appropriate management.