Mid-ventricular takotsubo: A case report

Is mid-ventricular takotsubo really a variant? Takotsubo cardiomyopathy (TCM) most commonly presents with both mid-ventricular and apical segment hypokinesia. Less frequently, the apical segment is spared and this variant has been termed mid-ventricular takotsubo. We present a case of a 66-year-old female with chest pressure and abnormal electrocardiography and positive troponin. Recently her mother was placed in hospice. Echocardiogram showed severe systolic dysfunction. She underwent left heart catheterization which included left ventriculogram that showed normal coronaries and basilar and apical hyperkinesis and mid-ventricular hypokinesia suggestive of mid ventricular takotsubo. We suggest that TCM can be thought of as a continuum in which the mid-ventricular segment is hypokinetic first and then the apical portion becomes hypokinetic later. Moreover, mid-ventricular hypokinesia is a key to a diagnosis of TCM; regardless of the presence of apical dyskinesia. The TCM merely presents in different ways and that the mid-ventricular variant is not a different disease entity from typical TCM.