Recurrent Takotsubo Syndrome with Variant Ballooning Pattern

Pedro Llerena,Francisco Besoain,Christian Dauvergne,José Luis Winter

doi:10.23937/2378-3656/1410326

Abstract

Takotsubo Syndrome usually presents with normal coronary arteries and the typical pattern of apical ballooning on the left ventricle. This entity can recur but very infrequently it presents with a different pattern of left ventricle wall motion abnormality. We describe the case of a 58-year-old woman presenting with recurrent TTS, associated with two different wall motion patterns in a period of nine years, triggered by a similar stressor factor.

Highlights

IntroductionTakotsubo Syndrome (TTS), known asStress-induced Cardiomyopathy, is a transient left ventricle (LV) regional dysfunction without significant coronary obstruction or plaque rupture [1]
Takotsubo Syndrome (TTS), known asStress-induced Cardiomyopathy, is a transient left ventricle (LV) regional dysfunction without significant coronary obstruction or plaque rupture [1].According to the modified Mayo Criteria, the diagnosis requires the presence of all four of the following: a) Transient hypokinesis, dyskinesis, or akinesis of the LV midsegments, with or without apical involvement; with wall-motion abnormalities that extend beyond a single epicardial vascular distribution; b) Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; c) Signs of ischemia withnew ECG abnormalities or modest elevation in the cardiac troponin level; d) Absence of pheochromocytoma or myocarditis.Clinically, four major anatomic patterns of regional wall motion abnormality have been recognized: Apical ballooning is the more frequent presentation that is present in approximately 81% of cases
Theories aim to overstimulation of hypothalamus pituitary adrenal axis that results in excessive release of catecholamines.Acute onset of TTS and its association with pheochromocytoma or paraganglioma have supported this theory

Summary

Introduction

Takotsubo Syndrome (TTS), known asStress-induced Cardiomyopathy, is a transient left ventricle (LV) regional dysfunction without significant coronary obstruction or plaque rupture [1]. Other variants have been described such as mid-ventricular (14%), basal or inverted (2%) and focal (1%) Recurrence of this entity is uncommon, and most cases present with similar wall motion abnormalities on relapse [2,3]. A 58-year-old woman with hypercholesterolemia, hyperuricemia and insulin resistance presented in the emergency room (ER) with 90 minutes of intense retrosternal chest pain, radiating to jaw and profuse sweating after a very stressful family event. She was hemodynamically stable without signs of heart failure on physical examination.

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