Chronic Stress and Early Recurrence of Takotsubo Cardiomyopathy: A Clinical Case

Abstract

Takotsubo cardiomyopathy (TC) is characterized by transient systolic dysfunction of the apical and middle segments of the left ventricle, accompanied by electrocardiographic abnormalities and mild elevation of cardiac biomarker levels in the absence of obstructive coronary artery disease. The following case is of a woman suffering from chronic emotional stress with a very early recurrence. An acute trigger event was not detectable in both cases. It is possible to suppose that, in predisposed subjects, chronic stress by increasing sympathetic activity may be considered not only a trigger for TC, but also a negative prognostic factor for early recurrence.

Keywords: Takotsubo cardiomyopathy; chronic stress; myocardial infarction.

Figure 1

Electrocardiogram registered upon admission (upper panel) and before discharge (lower panel)

Figure 2

Transthoracic echocardiogram recorded during the second in-hospital admission and showing apical akinesis, with basal segments hyperkinesis (left systolic frame, right diastolic frame)

Figure 3

Coronary angiography showing non-significant atherosclerotic lesions and ventriculography showing apical ballooning of the left ventricle