Broken Heart Syndrome: A Rare Case of Recurrent Reverse Takotsubo Cardiomyopathy Associated with Acute Respiratory Failure: Reverse Takotsubo Cardiomyopathy

Abstract

Background:
 Takotsubo cardiomyopathy accounts for 1% of acute coronary syndrome presentations and has been increasingly recognized.1 Reverse Takotsubo cardiomyopathy, a variant form of Takotsubo cardiomyopathy has been described which presents with hyperdynamic function of the apical segments and hypokinesis of the basal or mid-ventricular segments, is the rarest type of acute stress cardiomyopathy, with mid-ventricular akinesia and preservation of apical and basal contractility.2
 Case Report:
 We report the rare case of an elderly lady admitted to our intensive care unit (ICU) with acute respiratory failure due to exacerbation of chronic obstructive lung disease and heart failure. Echocardiography revealed reverse Takotsubo cardiomyopathy. Cardiac catheterization showed nonobstructive coronary artery disease. The wall motion abnormalities resolved in 2 weeks. The case is unique in that she had an identical presentation one year earlier after she had entered the same dusty room! 
 Conclusion:
 This case demonstrates that reverse Takotsubo cardiomyopathy with identical wall motion abnormalities can recur in a patient when re-exposed to similar stressful situation. Early recognition and appropriate management can prevent catastrophic outcomes.