Takotsubo Cardiomyopathy Secondary to Lung Transplantation Followed by Reduced Ejection Fraction Heart Failure: A Case Report

Takotsubo cardiomyopathy (TTC) is characterized by acute, transient left ventricular systolic dysfunction with regional wall-motion abnormalities. It is a form of stress-induced cardiomyopathy and can happen due to emotional or physical stress. Lung transplantation (LTx) is a major stressor that can lead to TTC. Its presentation with reversible left ventricular dysfunction and electrocardiographic (ECG) changes can mimic acute coronary syndrome (ACS), necessitating high clinical suspicion, particularly because of its potential for serious complications. We report a case of a 23-year-old male with cystic fibrosis who underwent bilateral LTx and developed TTC during surgery with a decrease in left ventricular ejection fraction (LVEF). Postoperative management included extracorporeal membrane oxygenation (ECMO), supportive medical therapy, and recovery of cardiac function within three weeks following LTx. Remarkably, one year posttransplantation he presented with reduced LVEF (30%) and pulmonary edema in the context of prior medication non-adherence. Echocardiography at that time showed reduced LVEF without wall-motion abnormality or apical ballooning, making TTC recurrence unlikely. With re-initiation of medical treatment, LVEF improved to approximately 35%. TTC should be considered in LTx recipients who present with acute left ventricular dysfunction and possible dynamic ECG changes because it can mimic ACS. Awareness of its risk following transplantation is crucial for timely diagnosis and management. Supportive management, including mechanical circulatory support such as ECMO, is vital during the acute phase. The morbidity and mortality associated with TTC are considerable; therefore, proper monitoring and treatment are essential. To our knowledge, TTC during LTx followed by late reduced LVEF during follow-up has rarely been reported.