Recurrence of Different Types of Takotsubo Cardiomyopathy

摘要

A 51-year-old female with a history of hypertension, and severe cyclic vomiting syndrome (CVS) secondary to gastroparesis, presented with acute onset nausea, vomiting, epigastric and substernal discomfort. Electrocardiogram (ECG) revealed non-specific T-wave abnormalities (Figure 1A-B) and serum troponin T was 5.54 ng/mL (normal value: 75% and normal wall motion. She had chest pain for 7 days in hospitalization, with ECG demonstrating diffuse T-wave inversion and new elevated serum troponin levels. TTE showed LVEF = 33% with segmental wall motion abnormalities involving akinesia of the distal two-thirds of the left ventricle, consistent with apical type of TCS (Figure 3C-D, Movie 2). She re-presented with CVS fourteen months later, had ECG changes and elevated troponin levels. TTE showed LVEF = 25% with akinesia and dyskinesia of the left ventricular mid-segments with relative sparing of the basal segments and apex (Figure 3E-F, Movie 3). Five months later, she had severe CVS again, with TTE showing LVEF = 45%, with hypokinesia of basal to mid-segments and hyperdynamic contraction of apical segments, consistent with basal type of TCS (Figure 4A-B, Movie 4). Of note, throughout these 2 years, TTE showed normal LVEF and wall motion when patient was asymptomatic (Figure 4C-D, Movie 5). This is an unusual case of TCS, with recurrent presentations of 3 different phenotypes induced by severe CVS.