Key result
Minor trauma precipitates an apical-to-mid-ventricular phenotypic switch in recurrent Takotsubo syndrome.
Why the study?
Recurrent Takotsubo syndrome may present with distinct phenotypes triggered by physical trauma, which is an underappreciated factor.
Case Report (n=1)
Serial multimodality imaging is essential to diagnose recurrent Takotsubo syndrome with an altered phenotype following minor physical trauma, which can occur despite standard pharmacotherapy.
Variant phenotypes in recurrent Takotsubo may follow minor trauma despite therapy; extends spectrum but leaves mechanisms and prevention open.
BACKGROUND: Takotsubo syndrome (TTS) typically presents as classic apical ballooning, but recurrent episodes may manifest a distinct phenotype. Physical trauma is an underappreciated potential trigger for atypical phenotypes. CASE SUMMARY: An 84-year-old woman with prior apical TTS sustained a ground-level fall with blunt chest trauma. Troponin I rose from 1,266 to 5,458 ng/L with new lateral T-wave inversions (aVL). Echocardiography showed mid-ventricular akinesia with a hyperkinetic apex (left ventricular ejection fraction ∼35%). Coronary angiography excluded obstructive disease; left ventriculography confirmed mid-ventricular variant TTS, and cardiac magnetic resonance showed myocardial edema without late gadolinium enhancement. Recurrence developed despite long-term beta-blocker and angiotensin-converting enzyme inhibitor therapy; left ventricular function recovered fully within 4 weeks. DISCUSSION: This case provides multimodality imaging documentation of an apical-to-mid-ventricular phenotypic switch in recurrent TTS precipitated by minor trauma. TAKE-HOME MESSAGE: Maintain high suspicion for recurrent TTS with altered phenotype after falls; serial multimodality imaging is essential; pharmacotherapy does not reliably prevent recurrence, so nonpharmacologic risk reduction is important.
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Khoury et al. (2026) conducted a case report in Recurrent Takotsubo Syndrome (n=1). Minor physical trauma (blunt chest trauma) was evaluated. Minor physical trauma from a fall precipitated an apical-to-mid-ventricular phenotypic switch in an 84-year-old woman with recurrent Takotsubo syndrome.
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