Patients Present With Recurrent Takotsubo Cardiomyopathy




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Takotsubo Cardiomyopathy (TTC) was first characterized by Sato and his research group in Japan 1990. It is characterized by hypokinesis of various sections of the heart wall in the left ventricle and most commonly ballooning of the apical section of the heart. These findings are generally resolved within 21 days of the onset without major intervention. Since its discovery many articles have focused on classifying the effects of TTC and case studies have illustrated interesting cases of TTC; however, few publications exist highlighting recurring cases of TTC. This publication focuses on two patients who presented with a recurring case of TTC. Case Presentation: Patient 1 first presented with a two-day history or worsening pain. Upon admission into the emergency department labs reported elevated troponin and low ejection fraction (EF) of 47%. Heart catheterization showed no signs of coronary artery obstruction but confirmed systolic compression at be decreased to 40%. Three years later the same patient presented with severe chest pain, shortness of breath, elevated troponin, and ST segment depression. Heart catheterization again showed no signs of coronary artery obstruction and reduced EF. Patient 2 first presented with pneumonia and sepsis. There were no indications for coronary issues however labs showed elevated troponin. Catheterization showed no signs coronary artery disease, but cardiac echogram demonstrated an EF of 20%. Seven years later the patient was brought to the hospital by emergency services with nausea, vomiting, diarrhea, loss of consciousness, and seizures. Labs revealed elevated troponin and acute ischemia. Follow up with an echo cardiogram showed severe hypokinesis and reduced EF of 25%. Conclusions: Due to how rare recurring cases of TCC are, there is little research regarding outcomes of patients with recurrent TCC. More case presentations and long-term statistics on these patients is required to build a more accurate picture of this cardiomyopathy and educate patients on their condition.