Recurrent Takotsubo cardiomyopathy in a postmenopausal Indian lady: Is there a pattern?

Citation metadata

Date: April-June 2019
From: Journal of Postgraduate Medicine(Vol. 65, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Case study
Length: 1,808 words
Lexile Measure: 1430L

Document controls

Main content

Article Preview :

Byline: N. Sharath Babu, S. Chacko, B. Chacko, A. Irodi

Takotsubo cardiomyopathy (TTC) is a syndrome of acute left ventricular dysfunction with a clinical presentation often mimicking acute coronary syndrome. Without a high index of suspicion, this clinical entity often goes unrecognized. Although initially categorized as a benign completely reversible condition, it is no longer considered to be so. Recurrence of this condition, though rare, has been reported in a non-Indian population. We present a case of recurrent TTC in a postmenopausal Indian lady who had a similar clinical presentation both at the index event and at recurrence.


Takotsubo cardiomyopathy (TTC) is an increasingly recognized entity of acute clinical heart failure, with significant morbidity and an in-hospital mortality of 2-5%.[1] Although described more commonly in postmenopausal women of Caucasian and Asian ethnicity, no race may be exempt. Recurrence, although rare, often adds to the morbidity of the disease. However, a second episode has been reported occurring from 3 months to even 10 years after the index event. Here, we describe Takotsubo syndrome in a postmenopausal Indian lady, who 8 months after the index event, presented with a similar clinical presentation as at the first episode, despite being on optimal medical therapy.

Case Report

A 59-year-old postmenopausal Indian lady with no diabetes, hypertension, and prior cardiac or renal disease presented to the emergency room with episodes of giddiness and dyspnea of 4 hours duration. She reported no other symptoms. Couple of days prior to the presentation, she acknowledged a definite stressful event at home while preparing for her youngest daughter's marriage which was to be held in a few days. Clinical examination showed mild tachycardia and no features of overt heart failure.

Electrocardiogram at admission showed sinus tachycardia, J-point elevation and concave upward ST elevation in V2-V6, T wave inversion in aVL, and a QTc of 402 ms [Figure 1]a. Troponin T was elevated at 493 pg/mL (normal up to 14 pg/ml), and subsequent values showed a downward trend. NT Pro-BNP was 1348 pg/ml (normal up to 125 pg/ml). Screening for pheochromocytoma was negative (urinary metanephrines of 60 [micro]g/24 h and normetanephrines of 311 [micro]g/24 h). Chest radiography was noncontributory.{Figure 1}

Echocardiography performed at admission showed moderate LV systolic dysfunction, regional wall motion abnormality involving the distal LV segments in a circumferential pattern-LV segments 13-17 (hypokinesia in apical inferior, apical lateral, apical anterior, apical septal areas and apex), but not corresponding to a single coronary arterial distribution [Figure 2], and preserved contractility of basal and mid LV segments. LV ejection fraction (EF) was measured as 37%, and there were no valvular abnormalities.{Figure 2}

Her coronary angiography done 8 months ago was normal and hence not repeated. Considering a working diagnosis of TTC...

Source Citation

Source Citation   

Gale Document Number: GALE|A584164888