Takotsubo Cardiomyopathy Associated With Work-Place Bullying

Background: Takotsubo cardiomyopathy (TC) is a condition of transient left ventricular dysfunction precipitated by acute physical or emotional stress. The pathogenesis of TC is not well understood, but it is known to predominantly affect postmenopausal women in the context of physical or emotional triggers. Aims: To describe a case of TC with an association to a never previously described work place stressor of bullying. Case Report: A 48-year-old female lawyer developed acute chest pain after experiencing significant emotional distress at a workplace meeting. She had experienced 18 months of increasing work-related mental stress in a new managerial role. She was initially thought to have a non-ST-elevation myocardial infarction (NSTEMI) with widespread T wave inversion on electrocardiogram and elevated serial troponin. However, a diagnosis of TC was subsequently made given the characteristic apical ballooning morphology of the left ventricle found on echocardiogram, normal coronary arteries on angiography and a normal echocardiogram 3 weeks later. This case report describes TC in a younger demographic and a link with workplace bullying. Conclusions: Chronic workplace bullying has the potential for serious physical harm by precipitating Takotsubo cardiomyopathy.