Takotsubo Cardiomyopathy in an Elderly Gravida with Twin Gestation

Takotsubo cardiomyopathy (TCM) is a cardiac emergency characterized by new-onset transient left ventricular systolic dysfunction with variable wall motion abnormalities without significant coronary artery obstructive disease. It presents with acute onset of chest pain, abnormalities in electrocardiogram, echocardiography, and elevated cardiac enzymes that are consistent with acute myocardial infarction. It is more common among postmenopausal women. However, it is reported in pregnant women in their third trimester and peripartum period. We present an elderly primigravida with twin gestation admitted for preterm labor that developed chest pain in the intrapartum period, followed by cardiogenic shock. On evaluation, diagnosed to have TCM and was successfully managed with a multidisciplinary team. TCM is a rare condition in the peripartum period, and it should be differentiated from myocardial infarction and peripartum cardiomyopathy as the lines of management and prognosis are different.