A Case of Takotsubo Cardiomyopathy with Parkinson’s and Possible Heroin Abuse

Takotsubo cardiomyopathy, in essence, is a reversible abnormality of the heart muscle resembling myocardial infarction in the absence of any disease of the coronary artery. A middle-aged man with medical history of Parkinson’s disease (PD) and substance abuse with heroin presents with chest pain. Apart from high blood pressure, he was haemodynamically stable. His troponins were elevated with a positive delta but had no ischemic changes on his electrocardiograms. He was treated as a non ST-segment elevated myocardial infarction (NSTEMI) and started on appropriate medications. His ejection fraction was found to be 35% and he had a large territory of the left ventricle apical akinesis. He was subsequently taken for a coronary angiogram which did not reveal any obstruction in his coronary arteries. This was deemed to be takotsubo cardiomyopathy and he was managed on Guideline Directed Medical Therapy. He was eventually discharged without any symptoms. Years of data have helped us gain insight into the etio-pathogenesis of this novel and rare condition, and although literature is limited, this case paves a path toward broadening our understanding about PD, coronary microvascular disease and takotsubo cardiomyopathy and their inter-connection.