SHM Converge Scientific Abstract ePoster Gallery-Atypical Case of Mid-Ventricular Takotsubo Cardiomyopathy

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This case describes a 66-year-old woman with hypertension, hyperlipidemia, prediabetes, and marginal zone B-cell lymphoma treated with rituximab who presented with nausea, vomiting, diaphoresis, chest discomfort, and dyspnea. She had no clear emotional or physical stressor and no recent illness. Initial evaluation showed sinus bradycardia, a markedly elevated troponin peak of 8,000 ng/L, and no ST-elevation on ECG.<br /><br />Because her presentation mimicked acute coronary syndrome, she underwent coronary angiography, which revealed only mild non-obstructive coronary artery disease. Left ventriculography demonstrated an atypical mid-ventricular Takotsubo pattern, with akinesis of the mid-anterolateral segment and hyperdynamic contraction of the apical and basal segments. Transthoracic echocardiography showed preserved left ventricular ejection fraction of 58% with mild mid-anteroseptal hypokinesis.<br /><br />She remained hemodynamically stable throughout hospitalization and was treated conservatively with aspirin, a statin, and a beta blocker. She was discharged with outpatient cardiology follow-up.<br /><br />The report highlights that Takotsubo cardiomyopathy is usually associated with apical ballooning after stress, but atypical variants such as the mid-ventricular form are less common and may be overlooked. This case is notable because it occurred without an identifiable trigger, broadening the clinical spectrum of the syndrome. The authors discuss possible mechanisms, including regional differences in beta-adrenergic receptor density and catecholamine sensitivity, as well as a possible role for immune modulation related to rituximab exposure.<br /><br />Overall, the case emphasizes the importance of recognizing atypical Takotsubo variants to avoid misdiagnosis as acute coronary syndrome and unnecessary invasive treatment.

Asset Subtitle

Kendall Conway

Meta Tag

Author List Geetha Krishnamoorthy, Karam Grewal, Kendall Conway, Muhammad Sanusi

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Apical Ballooning

Concept Apical Wall Motion Abnormality

Concept Catecholamine Sensitivity

Concept Acute Coronary Syndrome

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Kendall Conway

Track Adult

Keywords

Takotsubo cardiomyopathy

mid-ventricular variant

acute coronary syndrome

troponin elevation

coronary angiography

non-obstructive coronary artery disease

rituximab

beta blocker therapy

female patient

cardiomyopathy diagnosis

Takotsubo Cardiomyopathy

Apical Ballooning

Apical Wall Motion Abnormality

Catecholamine Sensitivity

Acute Coronary Syndrome