An Atypical Presentation of Takotsubo Cardiomyopathy

Background: Takotsubo cardiomyopathy is a reversible heart failure syndrome characterized by regional systolic dysfunction of the left ventricle. The syndrome mimics the presentation of myocardial infarction, yet it lacks evidence of obstructive coronary artery disease or plaque rupture. Case presentation: A 73-year-old Caucasian female presented to the Emergency Department with complaints of back pain following a non-syncopal fall after standing up too quickly and becoming dizzy the day previously. In addition, the patient complained of difficulty urinating and stooling for the past week. Her past medical history consisted of hypertension, hyperlipidemia, osteoporosis, and major depressive disorder. The patient was admitted, and a full workup was started. She was noted to have leukocytosis with blood cultures negative x2. Troponin I was also elevated at 5.42 and an ECG was performed which showed significant T wave inversions in V4 and V5 with a left axis deviation. CT Head, Cervical Spine, and Thoracic Spine without contrast showed no significant findings. An MRI of the lumbar spine was ordered to look for possible causes for her bladder and bowel retention but did not show spinal compression. In order to further evaluate the heart, an echocardiogram was performed and found global apical, septal, anterior akinesis with an estimated ejection fraction of 25-30%. Cardiology also performed a left heart catheterization (LHC), which found non-obstructive coronary artery disease. Conclusion: This case illustrates an atypical presentation of Takotsubo Cardiomyopathy due to the unique presentation and the unrelated symptoms that confused the clinical picture.