Conduction block in Takotsubo cardiomyopathy– an unexplained phenomenon

Case summary A 45-year-old female without any atherosclerotic risk factors had chest pain and pulmonary oedema one week after the death of her family member. ECG showed complete heart block. Echocardiogram and cardiac MRI showed left ventricular dysfunction with apical hypokinesia and basal hypercontractility. The coronary angiogram was normal, and a diagnosis of Takotsubo cardiomyopathy was made. She was treated with diuretics and an ACE inhibitor. Beta blockers were not used. On day 10, her left ventricular function recovered, but her ECG still showed complete heart block. Discussion Tachyarrhythmias are common in Takotsubo cardiomyopathy, but atrioventricular conduction blocks are rare. Takotsubo cardiomyopathy could have occurred secondary to complete heart block. But in this case, an apparent emotional trigger and a younger age to have a conduction system disease did not favour this. The occurrence of complete heart block in Takotsubo cardiomyopathy cannot be explained by catecholamine excess. Conclusions Conduction block can happen in Takotsubo cardiomyopathy. Its pathogenesis remains unclear and poses therapeutic challenges.