SHM Converge Scientific Abstract ePoster Gallery-Heartbreak in the Hospital: Atypical Presentation of Takotsubo Cardiomyopathy

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This case report describes an atypical presentation of Takotsubo cardiomyopathy (TC), or “broken heart syndrome,” in a 78-year-old woman with prior coronary artery disease, hypertension, hyperlipidemia, pulmonary embolism, and newly diagnosed pancreatic cancer. During hospitalization, she developed severe chest pain radiating to the left arm, similar to prior myocardial infarction pain. Despite stable vital signs and no ischemic ST/T changes on ECG, she had new atrial fibrillation and significantly elevated troponins, peaking at 2.950 ng/mL.<br /><br />Transthoracic echocardiography revealed new severe left ventricular dysfunction with an ejection fraction of 20–25% and apical ballooning, raising concern for Takotsubo cardiomyopathy. Because acute coronary syndrome needed to be excluded, left heart catheterization was performed. This showed an ejection fraction of 15% with apical ballooning but no significant obstructive coronary artery disease, confirming the diagnosis.<br /><br />The report emphasizes that TC can present with chest pain, dyspnea, arrhythmias, elevated cardiac biomarkers, and echocardiographic evidence of apical ballooning, but ECG findings may be absent or nonspecific. Diagnosis relies on clinical suspicion, cardiac enzymes, echocardiography, and coronary angiography to rule out ACS. Management is generally supportive and may include beta blockers, ACE inhibitors/ARBs, diuretics, and close cardiology follow-up. Most patients recover fully, often within weeks to months.<br /><br />This case highlights the importance of recognizing both typical and atypical features of Takotsubo cardiomyopathy, especially in hospitalized patients with major physical stressors such as cancer and pulmonary embolism.

Asset Subtitle

Michael C. Kim

Meta Tag

Author List Dylan Lopez, Manavjot Sidhu, Mark Lyons, Michael C. Kim

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Apical Ballooning

Concept Echocardiography

Concept Coronary Angiography

Concept Recovery

Distinguished Non-Finalist

Presenter Organization Methodist Dallas Medical Center

Presenting Author Michael C. Kim

Track Adult

Keywords

Takotsubo cardiomyopathy

broken heart syndrome

apical ballooning

chest pain

troponin elevation

atrial fibrillation

echocardiography

coronary angiography

acute coronary syndrome

pancreatic cancer

Takotsubo Cardiomyopathy

Apical Ballooning

Echocardiography

Coronary Angiography

Recovery