Focal Takotsubo Syndrome Mimicking a Distal Coronary Pathology: A Case Report

Takotsubo syndrome (TTS) is a transient stress-induced cardiomyopathy. It typically occurs following emotional or physical stressors. Many variants are described, the most common being the apical ballooning; however, atypical variants such as focal TTS are rare and can mimic acute coronary syndromes. We report the case of a 49-year-old woman presenting with chest pain and marked troponin elevation who underwent coronary angiography with left ventriculography demonstrating non-obstructive coronary arteries, inferior apical hypokinesis, and a subtle distal left anterior descending artery abnormality. Serial troponin testing confirmed a peak high-sensitivity troponin of 1,967 ng/L. In the context of emotional stress, absence of obstructive coronary disease, and atypical angiographic features inconsistent with plaque rupture or spontaneous coronary artery dissection, a diagnosis of focal TTS was considered most consistent. This case highlights the diagnostic challenges in identifying focal variants of Takotsubo cardiomyopathy.