Ivabradine in Takotsubo cardiomyopathy

The aim of this review is to present a case report of Takotsubo cardiomyopathy and to review the current literature. The second aim is to describe the role of ivabradine in the management of Takotsubo cardiomyopathy when intolerance for beta blockers occurs. MATERIALS: Case report and literature review of Takotsubo cardiomyopathy. RESULTS: A 52-year-old Caucasian female presented with Takotsubo cardiomyopathy triggered by severe emotional stress. Dmission electrocardiogram mimicked acute ST-segment elevation myocardial infarction , coronary angiography excluded significant coronary stenosis and left ventriculogram showed a typical Takotsubo cardiomyopathy apical ballooning appearance. Due to beta blocker intolerance, "off-label" treatment with ivabradine was initiated because of symptomatic sinus tachycardia. Echocardiography revealed normalization of the ejection fraction at outpatient follow-up. In the recent literature, ivabradine has been used in the management of different entities such as stable angina pectoris, congestive heart failure, inappropriate sinus tachycardia syndrome, postural tachycardia syndrome and Takotsubo cardiomyopathy. CONCLUSION: Takotsubo cardiomyopathy may be induced by witnessing a robbery. The patient was intolerant for beta blockers and had a favorable response to treatment with ivabradine. Ivabradine may be an alternative choice in cases where there is an intolerance of beta blockers. We present an exceedingly rare case of Takotsubo cardiomyopathy induced by uncommon severe emotional stress, catching her colleague stealing money from the cash register, which was associated with sinus tachycardia in a female patient with intolerance for beta blockers. The patient responded well to treatment with oral ivabradine. The literature is briefly reviewed