March 3, 2026CureusOpen Access

The Shape-Shifting Heart: Recurrent Takotsubo Cardiomyopathy Manifesting as Two Variants in One Patient

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Why the study?

Recurrence of Takotsubo cardiomyopathy is uncommon, and recurrence presenting with distinct morphologic variants is exceedingly rare.

Key Points

Takotsubo cardiomyopathy led to acute chest pain and troponin elevation, indicating critical cardiovascular events.
Echocardiography showed left ventricular dysfunction with an ejection fraction of 35-40% post-surgery.
Observational analysis confirmed mid-ventricular variant of Takotsubo cardiomyopathy, differing from previous apical variant.
Recognition of variant-specific triggers may enhance management strategies for recurrent Takotsubo cardiomyopathy.

Structured PICO

Population

1 75-year-old female with peripheral arterial disease, paroxysmal atrial fibrillation, sick sinus syndrome status post pacemaker, and prior apical variant Takotsubo cardiomyopathy.

This case demonstrates the rare phenomenon that Takotsubo cardiomyopathy can recur with distinct morphologic variants in the same patient.

Implication

Clinicians should anticipate morphologic variability in recurrent Takotsubo; extends phenotypic spectrum but remains hypothesis-generating.

Abstract

Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, is a transient left ventricular dysfunction that mimics acute coronary syndrome but typically resolves within weeks. Its recurrence is uncommon, and recurrence with distinct morphologic variants is exceedingly rare. We report a 75-year-old female with peripheral arterial disease, paroxysmal atrial fibrillation, sick sinus syndrome status post pacemaker, and prior apical variant TCM in 2022. She underwent a right lower extremity surgery. Two days postoperatively, she developed acute chest pain and troponin elevation. Echocardiography revealed new left ventricular dysfunction with an ejection fraction (EF) of 35-40% and hypokinesis of the anteroseptal and anterior walls. Coronary angiography demonstrated mild nonobstructive coronary artery disease (CAD). Ventriculography confirmed the mid-ventricular variant of TCM. This contrasted with her prior episode in 2022, when she developed apical ballooning variant TCM with an EF of 25-30% during admission for Escherichia coli bacteremia. In both episodes, her EF normalized on follow-up imaging. This case highlights the protean nature of TCM and the rare phenomenon of recurrence with different morphologic variants. Recognition of variant-specific triggers and long-term surveillance are essential in patients with prior episodes.