Reverse takotsubo cardiomyopathy

Description of Clinical Presentation: A 65-Y-F suffered cardiac arrest due to ventricular fibrillation during colonoscopy. Elevated Troponins were found. Patient was revived in the emergency and sent for cardiac MRI evaluation. Coronary angiogram was normal.

Diagnostic Techniques and Their Most Important Findings: A cardiac MRI was performed on 1.5 T scanner with cardiomyopathy protocol at Toronto general hospital. Routine Cine sequences in short and long axis, edema sequence, parametric maps and LGE sequences were performed using dedicated cardiac coil.

CMR findings: The left ventricle showed mild dilatation with mildly reduced global systolic function with EF of 43%. The basal to mid cavity was hypokinetic with hypercontractility of the apex. Myocardial edema was seen in basal to mid LV with raised T1 and T2 values with a basal to apical gradient. Circumferential small pericardial effusion was seen. No late gadolinium enhancement.

Learning Points from this Case: Findings and clinical presentation were compatible with reverse Takotsubo cardiomyopathy.

Learning points:

1. Takotsubo cardiomyopathy is a rare but potentially cardiomyopathy which can lead to acute ventricular fibrillation, heart failure and cardiac arrest.

2. Any physical or emotional stress can induce Takotsubo cardiomyopathy mimicking myocardial infarction.

3. Reverse form of Takotsubo cardiomyopathy is a rare variant with basal ballooning. Although commonly described in younger age group with lesser hemodynamic compromise but this case highlights its occurence in older group with grave clinical outcomes.

Basal balloning of Left ventricle during systole.