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A dynamic variant of Takotsubo cardiomyopathy mimicking apical hypertrophic cardiomyopathy: a case report.

Eur Heart J Case Rep

January 2025

Cardiovascular and Thoracic Division, Cardiology Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.

Background: Takotsubo cardiomyopathy usually presents with acute reversible left ventricular apical hypokinesia and apical ballooning with basal hyperdynamic function. We describe an underreported case of Takotsubo cardiomyopathy (TCM), misinterpreted as apical hypertrophic cardiomyopathy (HCM) due to transient apical oedema in the recovery phase of the condition.

Case Summary: A 74-year-old Caucasian woman, presented to the emergency department complaining of retrosternal chest pain following, emotional stress.

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Background: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and wall motion abnormalities without culprit coronary artery disease. LV thrombus (LVT) formation during the acute phase is a fearsome complication.

Objectives: To identify factors associated with LVT and its prognostic impact in TTS patients.

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Background: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. It usually presents with clinical features similar to acute coronary syndrome, making its occurrence following elective percutaneous coronary intervention (PCI) challenging to diagnose and treat.

Case Summary: A 67-year-old man with ischaemic heart disease and recurrent angina underwent elective PCI of the right coronary artery.

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Atrial fibrillation (AF) catheter ablation is safe and effective, though rare cases of takotsubo syndrome (TTS) have been observed without proven causation. This review synthesizes TTS following AF ablation case reports and series. Until October 2024, PubMed/Medline, SCOPUS, and Google Scholar were searched for AF ablation and TTS case reports and series.

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This case emphasizes the rare occurrence of Takotsubo cardiomyopathy (TTC) in a patient with moderate coronary artery disease (CAD), highlighting the complexity of diagnosis and management. Clinicians should maintain a high index of suspicion for TTC in patients with CAD, especially when echocardiographic findings suggest apical ballooning. Balancing therapies for both conditions is essential.

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