Takotsubo cardiomyopathy and Graves’ disease

Takotsubo cardiomyopathy (TTC), first described in 1990 by Sato et al. [1], has been increasingly recognised in recent years as a condition clinically mimicking acute myocardial infarction.Coronary artery disease coexists in 15% of patients with TTC and therefore cannot be used to rule out the disease [2].It is characterised by apical ballooning with transient left ventricular dysfunction.The left ventricle has the shape of a Japanese octopus fishing pot with a narrow neck and round bottom, called a takotsubo.In two thirds of patients the condition is triggered by physical or emotional stress while in one third of patients no trigger is evident.Common physical triggers include acute respiratory failure, operations, fractures, central nervous system conditions and infections.The disease is most commonly seen in postmenopausal women.Left ventricular function usually recovers within a couple of weeks [2, 3].Nevertheless, newer data show that it is a life-threatening condition in the acute phase and associated with substantial long-term morbidity and mortality [2].We present here a rare case of TTC in the setting of Graves' hyperthyroidism without any of the known usual triggers.Summary While Graves' disease has been a well-known clinical entity for some time, takotsubo cardiomyopathy (TTC) has become recognised as an acute heart failure syndrome only in recent years.Typically physical or emotion al stress triggers the disease, but pathophysiological mechanisms remain poorly understood.We report a case of TTC in the setting of Graves' disease in absence of the usual triggers.After pharmacological treatment the patient improved rapidly, and cardiac function fully recovered within 1 month.