SHM Converge Scientific Abstract ePoster Gallery-Surges Through the Heart: Reverse Takutsubo Cardiomyopathy

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This case report describes reverse takotsubo cardiomyopathy, a rare stress-induced form of cardiomyopathy in which the basal left ventricle becomes akinetic or hypokinetic while the apex remains hypercontractile. Unlike classic takotsubo cardiomyopathy, which affects the apical region, reverse takotsubo is uncommon and often triggered by physical or emotional stress.<br /><br />The patient was a 68-year-old man with dementia, chronic alcohol use, seizure disorder, and adrenal insufficiency who presented with generalized weakness, chills, poor oral intake, encephalopathy, hypotension, and significant unintentional weight loss. Initial imaging showed no acute findings aside from a hydropic gallbladder. He was treated with stress-dose hydrocortisone, intravenous fluids, and norepinephrine, but remained hypotensive and bradycardic. Troponin levels rose, prompting cardiology evaluation for shock and possible ischemia. Cardiac catheterization showed only mild coronary artery disease, but left ventriculography demonstrated basal akinesis with a hypercontractile apex. Echocardiography showed reduced ejection fraction (35–40%) with global hypokinesis.<br /><br />The authors suggest that the patient’s severe weight loss, anorexia, poor oral intake, and possible adrenal insufficiency likely triggered the episode. The case supports the idea that catecholamine excess or abnormal receptor distribution within the myocardium may contribute to reverse takotsubo cardiomyopathy. This condition often reverses over time and may be recognized best by ventriculography or echocardiography showing basal ballooning with minimal coronary disease.

Asset Subtitle

Vijay Kuppurajan

Meta Tag

Author List Khashayar Vahdat, Vijay Kuppurajan

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Reverse Takotsubo Cardiomyopathy

Concept Transient Left Ventricular Wall Motion Abnormality

Concept Apical Takotsubo Cardiomyopathy

Concept Cardiogenic Shock

Distinguished Non-Finalist

Presenter Organization Christus Good Shepherd Medical Center/Texas A&M School of Medicine

Presenting Author Vijay Kuppurajan

Track Adult

Keywords

reverse takotsubo cardiomyopathy

stress-induced cardiomyopathy

basal akinesis

hypercontractile apex

adrenal insufficiency

cardiogenic shock

echocardiography

left ventriculography

troponin elevation

mild coronary artery disease

Takotsubo Cardiomyopathy

Reverse Takotsubo Cardiomyopathy

Transient Left Ventricular Wall Motion Abnormality

Apical Takotsubo Cardiomyopathy

Cardiogenic Shock