Stress-Induced Takotsubo Cardiomyopathy Identified by Unique Nuclear Perfusion Pattern

Takotsubo cardiomyopathy (TC) is a stress-induced, reversible left ventricular dysfunction syndrome. Historically diagnosed via echocardiography and coronary angiography, nuclear imaging techniques have added utility and enhanced diagnostic accuracy. We present a case of a 49-year-old female who presented with dyspnea and was diagnosed with TC with the aid of nuclear myocardial perfusion imaging (MPI), which was confirmed with invasive coronary angiography. Upon arriving at the ED, the patient's ECG demonstrated a normal sinus rhythm with nonspecific ST changes. An echocardiogram indicated a cardiomyopathy with an LVEF of 30-35%, hyperkinesis of the base, and hypokinesis of the apex. A nuclear stress test revealed a large, severe fixed defect in the circumferential apical territories, with the bases spared, raising suspicion for TC. The patient underwent cardiac catheterization, which demonstrated non-obstructive coronary artery disease. LV gram confirmed hypercontractility of the basal segments with akinesis of the apex, consistent with TC. She was initiated on goal-directed medical therapy with full resolution of her wall motion abnormalities on her follow-up visit. TC can mimic acute coronary syndrome (ACS), and coronary angiography is the gold standard for differentiating these entities. Nuclear imaging can aid clinicians between ACS and TC by demonstrating an apical defect that does not correlate with a coronary artery territory.