Takotsubo Cardiomyopathy Caused by Gastritis Without Typical Stressors: A Case Report

Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction in the absence of significant coronary artery disease. First described in Japan in the 1990s by Sato et al., this unique reversible cardiomyopathy typically occurs in post-menopausal women and is frequently triggered by physical or physiological stress. Despite numerous studies, the pathogenesis and etiology of TCM are incompletely understood. However, the overlap in the initial clinical presentation of TCM and acute coronary syndrome (ACS), the increasing incidence of TCM, particularly after the COVID-19 pandemic, and the comparable long-term mortality risk of TCM patients highlight the importance of a better understanding of this condition. Less common triggers, including gastrointestinal disturbances, have been associated with TCM, as will be discussed in this case report. This case presents a 46-year-old female who was admitted to the hospital with epigastric pain and vomiting and later developed chest pain with elevated cardiac biomarkers and ECG changes. Following a diagnosis of suspected non-ST elevation myocardial infarction (NSTEMI), coronary angiography revealed unobstructed coronary arteries and magnetic resonance imaging confirmed TCM. This case highlights that TCM can be triggered by non-classical stressors such as prolonged gastrointestinal symptoms. Early recognition and appropriate management can lead to a favorable prognosis.