Multimodal Imaging Approach for the Diagnosis of Focal Takotsubo Cardiomyopathy in a Postmenopausal Woman

Stress-induced cardiomyopathy (Takotsubo syndrome) is a condition characterized by temporary impairment of the left ventricular function that could present with features similar to acute coronary events or non-obstructive myocardial infarction (MINOCA). We present the case of a 72 years old female who had a past medical history of hypertension, type 2 diabetes mellitus and a cerebrovascular accident, who presented with an episode of intermittent, atypical angina. Her vitals were stable with a normal ECG but had elevated high-sensitivity troponin I levels at 656 ng/L. Echocardiography showed mid-anteroseptal hypokinesia, while a prior coronary CT angiography revealed an absence of coronary calcification with no coronary disease, and cardiac MRI demonstrated localized myocardial edema without late gadolinium enhancement, consistent with focal TCM. Symptoms resolved after treatment and left ventricular function normalized within the next six months. Upon further investigation, an emotional stressor was identified, which supports the diagnosis of TCM. This case highlights the importance of imaging, especially cardiac MRI, in differentiating focal TCM from other differential diagnoses, like myocarditis or acute coronary syndrome.