Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 677-684
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.677
Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report
Hao-Yu Wu, Gong Cheng, Lei Liang, Yi-Wei Cao
Hao-Yu Wu, Gong Cheng, Lei Liang, Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Yi-Wei Cao, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Wu HY drafted the manuscript; Wu HY, Cheng G and Liang L participated in the treatment of this patient; Wu HY, Cao YW and Cheng G revised the manuscript; All authors have read and approved the final version of the manuscript.
Supported by Natural Science Basic Research Program of Shaanxi Province, No. 2020JQ-939; and Science and Technology Development Incubation Fund Project of Shaanxi Provincial People’s Hospital, No. 2019YXQ-08.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao-Yu Wu, MD, PhD, Chief Doctor, Research Fellow, Department of Cardiology, Shaanxi Provincial People’s Hospital, No. 256 West Youyi Road, Xi’an 710068, Shaanxi Province, China. wxs5132006@163.com
Received: September 11, 2020
Peer-review started: September 11, 2020
First decision: November 14, 2020
Revised: November 24, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 26, 2021
Processing time: 131 Days and 3.2 Hours
Abstract
BACKGROUND

Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.

CASE SUMMARY

A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient’s hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.

CONCLUSION

Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.

Keywords: Takotsubo cardiomyopathy; Stress-induced cardiomyopathy; Emotionally stressful event; Recurrent events; Chest pain; Case report

Core Tip: Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, Takotsubo cardiomyopathy (TCM) should be considered in some clinical settings. Recurrent TCM triggered by emotional stress is rare. Early appropriate supportive treatments can avert adverse outcomes and ensure a good prognosis for patients with TCM. We hope that this case will increase our attention to the diagnosis of TCM.