Background
Takotsubo Cardiomyopathy (TCM) is an acute but mostly reversible left ventricular dysfunction that occurs as a result of physical or emotional stress. It is characterized by hypokinesis or akinesis of the apical segments with hyperkinesis of the basal walls. Reverse takostubo cardiomyopathy (rTCM) is the opposite and entails basal hypokinesis or akinesis with apical hyperkinesis.
Case
A 55-year-old female with no past medical history presented with substernal chest pain for the last five days since having a neardrowning experience. EKG showed inferolateral T-wave flattening. Initial troponin was 0.27 ng/dL which increased to 0.46 ng/dL before trending back down. She was started on medical therapy for a possible acute coronary syndrome.
Decision-making
A transthoracic echocardiogram showed akinetic mid-anterolateral and hypokinetic mid-anterior, anteroseptal and inferolateral segments with an ejection fraction of 47%. A coronary angiogram did not show any angiographic evidence of coronary artery disease. Diagnosis of rTCM was made and she was discharged home in stable condition with medical management.