SHM Converge Scientific Abstract ePoster Gallery-A Rare Recurrence of Reverse Takotsubo Cardiomyopathy After Seven Years in the Setting of Hypertensive Crisis: A Case Report

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This case describes a rare recurrence of Takotsubo cardiomyopathy in a 66-year-old woman, seven years after her initial episode. She presented with acute abdominal pain, nausea, vomiting, diaphoresis, hypertensive urgency, and hypoxic respiratory distress requiring BiPAP. Chest imaging showed bilateral pulmonary edema, and cardiac biomarkers were elevated, raising concern for acute coronary syndrome or demand ischemia.<br /><br />Transthoracic echocardiography revealed a reverse Takotsubo pattern: preserved overall left ventricular systolic function with severe basal hypokinesis/akinesis and hypercontractile mid and apical segments. Coronary angiography showed only mild nonobstructive coronary artery disease, confirming stress-induced cardiomyopathy rather than obstructive ischemia. During catheterization, she developed atrial flutter with rapid ventricular response, which converted spontaneously to sinus rhythm. She improved with carvedilol up-titration and diltiazem, later transitioned to oral therapy. Flecainide was stopped because of rare reports linking it to Takotsubo recurrence. Her troponins declined, pulmonary edema resolved, and she was discharged stable with close cardiology and electrophysiology follow-up.<br /><br />The report emphasizes that recurrent Takotsubo syndrome is uncommon, occurring in about 4% of cases, and the reverse (basal) variant is especially rare, seen in roughly 2%. This atypical form can mimic acute coronary syndrome or pulmonary edema and may be difficult to recognize without echocardiography and coronary angiography. In this patient, a hypertensive crisis with intense sympathetic activation likely triggered the event. The case highlights the importance of considering recurrent Takotsubo in patients with prior history who present with acute stress-related symptoms and unusual wall-motion abnormalities.

Asset Subtitle

Andrea Rodriguez Jimenez

Meta Tag

Author List Adriana Morales Rivera, Andrea Rodriguez Jimenez, Juan Rivera Martinez, Juan Rodriguez Padilla, Sai Wan

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Echocardiography

Concept Coronary Angiography

Concept Stress

Concept Acute Coronary Syndrome

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Andrea Rodriguez Jimenez

Track Adult

Keywords

Takotsubo cardiomyopathy

recurrent Takotsubo syndrome

reverse Takotsubo

basal hypokinesis

acute coronary syndrome mimic

pulmonary edema

hypertensive urgency

atrial flutter

coronary angiography

stress-induced cardiomyopathy

Takotsubo Cardiomyopathy

Echocardiography

Coronary Angiography

Stress

Acute Coronary Syndrome