Abstract 4366821: Stress Cardiomyopathy Without Acute Stress: Potential Delayed Impact of a Neurological Insult

Background: Takotsubo syndrome (TTS) is a reversible cardiac condition typically triggered by acute stress, causing transient left ventricular dysfunction. Neurological insults like subarachnoid hemorrhage (SAH) can precipitate TTS, usually within days. Delayed TTS presentations without acute stressors are rare and poorly understood. We report a unique case of TTS occurring three months post-SAH, highlighting latent brain-heart interactions. Case Discussion: A 71-year-old postmenopausal woman presented with acute dyspnea and elevated troponin (2900 pg/mL). Her history included traumatic SAH three months prior with a normal echocardiogram at that time. Electrocardiogram showed non-specific T-wave changes. Transthoracic echocardiography revealed severe left ventricular dysfunction (ejection fraction 25-30%) with apical ballooning and mid-to-apical hypokinesis, consistent with TTS. Coronary angiography confirmed non-obstructive coronary arteries. No recent stressors or acute neurological events were identified, suggesting a delayed TTS linked to the prior SAH. Heart failure therapy was initiated; follow-up echocardiography is pending. Conclusions: This case demonstrates a rare delayed TTS presentation three months post-SAH, challenging the typical acute timeline. It underscores the need for extended cardiac monitoring in SAH patients, particularly postmenopausal women, to detect latent cardiac effects. Prospective studies are essential to elucidate the pathophysiology and temporal variability of delayed TTS.