Key result
Recurrent Takotsubo cardiomyopathy can affect different myocardial segments in the same patient, challenging the beta receptor gradient theory and occurring despite chronic beta blocker and ACE inhibitor therapy.
Why the study?
Discrepant gradients of beta-2 adrenoceptors are thought to determine different anatomic variants of Takotsubo cardiomyopathy, but the recurrence of different variants in the same patient is not well understood.
Case Report (n=1)
No
The recurrence of Takotsubo cardiomyopathy with a different anatomic variant in the same patient challenges the prevailing beta adrenoceptor distribution theory.
May prompt consideration of reverse Takotsubo in younger patients; leaves open receptor-mediated mechanisms for anatomic variants.
Background: Classic Takotsubo cardiomyopathy has been described as transient apical dyskinesia following major stress that is believed to be related to catecholamine surges. Atypical variants have been described, including the rarer reverse Takotsubo cardiomyopathy. Discrepant gradients of the beta-2 adrenoceptors are thought to determine the different anatomic variants. Case Report: A 43-year-old female presented with chest pain and a mild troponin elevation. Echocardiography and coronary angiography were consistent with stress-induced apical Takotsubo cardiomyopathy. Eight months later, the patient was admitted with a similar presentation; however, workup revealed stress-induced reverse Takotsubo cardiomyopathy. Conclusion: Recurrent Takotsubo cardiomyopathy involving different anatomic regions of the left ventricle is a rare phenomenon yet appears to be similar to typical Takotsubo cardiomyopathy in presentation and hospital course. Chronic therapy with beta blockers and angiotensin-converting enzyme inhibitors did not prevent a recurrence in this patient, suggesting that optimum treatment needs to be determined. Takotsubo cardiomyopathy affecting different myocardial segments may recur in the same patient, implying that the adrenoceptor distribution theory needs further refinement.
No takes yet. Share an insight, caveat, or question.
Rashed et al. (2019) conducted a case report in Takotsubo cardiomyopathy (n=1). Beta blockers and angiotensin-converting enzyme inhibitors was evaluated. Recurrent Takotsubo cardiomyopathy can affect different myocardial segments in the same patient, challenging the beta receptor gradient theory and occurring despite chronic beta blocker and ACE inhibitor therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: