What is the clinical evidence from this study?

Study design: Case Report. Population: Takotsubo Cardiomyopathy and Myocardial Bridge (n=1). Intervention: Supportive care, diltiazem, and ICD placement. Primary outcome: Survival and neurological recovery.

What does this research mean for the field?

Out-of-hospital cardiac arrest can serve as the initial presentation of Takotsubo cardiomyopathy, and accurate diagnosis in the presence of coexisting severe myocardial bridging requires multimodality imaging and physiological assessment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This report aims to illustrate that out-of-hospital cardiac arrest can be the first indication of Takotsubo cardiomyopathy, especially in the presence of severe myocardial bridging.

June 14, 2026Cureus0 citationsOpen Access

Out-of-Hospital Cardiac Arrest As the Initial Presentation of Takotsubo Cardiomyopathy in the Presence of Severe Myocardial Bridge: A Diagnostic Challenge

AOAbeer Omar OMOmar MakawiHamad General Hospital MAMotaz AlmahmoodPhoenixville Hospital

Key Result

A 45-year-old woman successfully recovered from an out-of-hospital cardiac arrest as the initial presentation of Takotsubo cardiomyopathy coexisting with severe myocardial bridging.

Key Points

This report aims to illustrate that out-of-hospital cardiac arrest can be the first indication of Takotsubo cardiomyopathy, especially in the presence of severe myocardial bridging.
Case report of a 45-year-old woman experiencing out-of-hospital cardiac arrest due to ventricular fibrillation.
Coronary angiography and physiological assessment using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) were performed.
Transthoracic echocardiogram (TTE) assessed cardiac function and identified apical ballooning.
Coronary angiography revealed severe myocardial bridging, complicating the diagnosis.
Echocardiogram showed apical ballooning with reduced ejection fraction that improved rapidly, supporting TC diagnosis.
Physiological assessment indicated no significant flow limitation due to myocardial bridging.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 45-year-old premenopausal woman presenting with out-of-hospital cardiac arrest due to ventricular fibrillation, diagnosed with Takotsubo cardiomyopathy and severe myocardial bridging.

Intervention

Multimodality imaging (TTE, coronary angiography, IVUS, cardiac MRI) and physiological assessment (iFR/FFR), followed by supportive ICU care, diltiazem, and implantable cardioverter-defibrillator (ICD) placement.

Outcome

Diagnosis of Takotsubo cardiomyopathy coexisting with severe myocardial bridging, and clinical recovery.

This case demonstrates that Takotsubo cardiomyopathy can present as out-of-hospital cardiac arrest and highlights the utility of physiological assessment (FFR/iFR) in distinguishing it from ischemia caused by coexisting myocardial bridging.

Limitations

Delayed timing of cardiac MRI likely limited its sensitivity in detecting acute takotsubo changes.

Abstract

Takotsubo cardiomyopathy (TC) is characterized by transient, reversible systolic dysfunction in the absence of angiographic evidence of obstructive coronary artery disease (CAD). TC often mimics acute coronary syndrome (ACS) and is frequently precipitated by emotional or physical stress. In this report, a 45-year-old woman experienced out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation. Coronary angiography (CAG) identified severe myocardial bridging (MB), complicating the diagnostic process. Physiological assessment with instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) revealed no significant flow limitation attributable to MB. Transthoracic echocardiogram (TTE) demonstrated apical ballooning with reduced ejection fraction, which improved rapidly. These findings supported the diagnosis of TC. This case demonstrates that cardiac arrest (CA) can be the initial manifestation of TC. Clinicians should consider TC in patients presenting with CA or chest pain, particularly when reversible left ventricular dysfunction with apical ballooning is present. When MB coexists with TC, multimodality imaging and physiological assessment are critical for accurate diagnosis.

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