Takotsubo Cardiomyopathy in the Absence of an Identifiable Emotional Stressor

This is a case presentation of a 61-year-old female with a history of long-term asymptomatic left bundle branch block and recurrent nephrolithiasis who presented to the emergency department with chest pain that radiated to the left shoulder and jaw, nausea, vomiting, and generalized weakness. On admission, the electrocardiogram showed prolonged QRS complex, significant T-wave inversions in leads V2-V4, and left bundle branch block. Troponin I serum levels were found to be markedly elevated. The echocardiogram demonstrated left ventricular hypokinesis. The patient was admitted for treatment of non-ST-elevation myocardial infarction and was placed on a heparin drip with daily aspirin and high-intensity statin. Cardiac catheterization showed angiographically normal coronary arteries with no signs of obstruction or stenosis. Upon questioning, the patient did not endorse any recent emotionally or physically triggering incidents. Despite the lack of an identifiable emotional stressor, the patient met the diagnostic criteria for takotsubo cardiomyopathy (TTC) and was subsequently placed on evidence-based medical therapy. While most individuals with TTC will fully recover their cardiac function with proper treatment, a subset of patients may continue to have symptoms of persistent heart failure following their initial diagnosis. The pathophysiology of TTC is still not well understood. While the leading theory describes a catecholamine surge secondary to an emotionally or physically triggering event causing myocardial injury and subsequent temporary cardiac dysfunction, further research must be done to understand the underlying pathophysiology of this condition fully.