Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult

Aelaf Aseged Mammo; Amirhossein Farahani; Yasin Salari Sabzevaran; Sachi Jaydipsinh Chavda; Mirab Singh; Hemeesh Tandel; Zhang Ming

doi:doi:10.11648/j.ajim.20251301.11

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Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult

Aelaf Aseged Mammo

, Amirhossein Farahani

, Yasin Salari Sabzevaran

, Sachi Jaydipsinh Chavda

, Mirab Singh

, Hemeesh Tandel

, Zhang Ming^*

Published in American Journal of Internal Medicine (Volume 13, Issue 1)

Received: 22 November 2024 Accepted: 12 December 2024 Published: 17 January 2025

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Abstract

Takotsubo cardiomyopathy (TTC), or "broken heart syndrome," is a transient cardiac condition marked by left ventricular dysfunction, often triggered by emotional or physical stress. This case report discusses a 28-year-old female who developed TTC after the sudden loss of a close family member. She presented to the emergency department with acute chest pain, dyspnea, and anxiety, resembling acute myocardial infarction. ECG showed ST-segment elevations and T-wave inversions, while lab tests revealed elevated cardiac biomarkers, including troponin. An echocardiogram confirmed classic apical ballooning, and coronary angiography ruled out obstructive coronary artery disease, showing normal arteries. The patient received supportive care, including beta-blockers and anxiolytics, and her symptoms improved, with follow-up echocardiography showing normal left ventricular function within weeks. This case highlights the need for awareness of TTC in younger patients under emotional stress and the importance of timely diagnosis and management to avoid unnecessary interventions.

Published in	American Journal of Internal Medicine (Volume 13, Issue 1)
DOI	10.11648/j.ajim.20251301.11
Page(s)	1-6
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Takotsubo Cardiomyopathy, Stress-Induced Cardiomyopathy, Emotional Stress, Chest Pain, Dyspnea

1. Introduction

Takotsubo cardiomyopathy (TTC), commonly referred to as "broken heart syndrome," is a reversible cardiac disorder that manifests as acute left ventricular dysfunction, closely mimicking acute myocardial infarction (AMI)

[1]

. Initially reported in Japan during the early 1990s, TTC typically occurs in response to emotional or physical stress, resulting in a unique pattern of myocardial damage that differs from that seen in conventional coronary artery disease (CAD)

[2, 3]

. This condition predominantly affects postmenopausal women, although its incidence among younger populations is on the rise. Patients often present with symptoms such as chest pain, dyspnea, palpitations, and gastrointestinal discomfort, which can lead to misdiagnosis as acute coronary syndrome

[4]

. Diagnostic evaluations usually reveal ST-segment elevation and T-wave inversions on electrocardiograms (ECG), elevated cardiac biomarkers, and echocardiographic evidence of apical ballooning

[5]

. Notably, coronary angiography typically shows normal coronary arteries, aiding in the differentiation of TTC from other cardiac conditions

[6]

. Recognizing these factors is essential for early diagnosis and treatment, as most patients experience a favorable outcome, regaining cardiac function within weeks

[7]

1.1. Objectives of the Case Report

This case report aims to:

1. Highlight the clinical presentation and diagnostic challenges associated with Takotsubo cardiomyopathy in a young adult.

2. Emphasize the role of emotional stressors in precipitating TTC.

3. Contribute to the existing literature by documenting a case that underscores the importance of recognizing TTC in younger populations.

1.2. Status of Knowledge in Related Fields

Recent studies have expanded the understanding of TTC, revealing its potential occurrence in younger individuals and the critical role of psychological factors in its pathophysiology. Research indicates that while TTC is more prevalent in older women, younger patients can also be affected, often following significant emotional distress

[8]

. Furthermore, the recognition of TTC as a distinct clinical entity has led to improved diagnostic criteria and management strategies, although many healthcare providers remain unaware of its nuances

[9]

2. Case Presentation

A 27-year-old Indigenous male who had an alcohol dependence and no other cardiovascular risk factors, complained of epigastric pain, nausea, vomiting and diaphoresis two days after binge drinking. He later developed chest pain. Physical examination revealed he was tachycardic with heart rate of 110 bpm, and febrile with temperature of 38.4 celsius degree, which manifested right upper quadrant pain. Laboratory investigations showed lipase to be raised with a value of 1310 U/L, leukocytes count of 17.2 × 10⁹/L and marginally deranged liver enzymes, uptake of bilirubin was 26 µmol/L, alkaline phosphatase 118 U/L, gamma-glutamyl transpeptidases 101 U/L, alanine aminotransferases 109 U/L Kidney function was also normal (creatinine 76 µmol/L) while triglycerides level was high (2.5 mmol/L). Trends of serial troponin were increased from 0.77 ng/mL to 1019.63 ng/mL, ECG revealed ST-segment elevation in anterior leads, therefore, anterior ST-elevation Myocardial Infarction was diagnosed at the initial assessment. He had thrombolysis, put on dual antiplatelet and LMWH therapy and then was shifted to CCU. A repeated ECG demonstrated partial ST segment resolution and q waves. The transthoracic echocardiography was suggestive of significant left ventricular dysfunction with an ejection fraction of 20%. Subsequent studies showed non stenotic lesion of the right coronary artery basal hypokinesis and apical akinesis. The final diagnosis presented was Takotsubo cardiomyopathy (TCM). Use of dual antiplatelet therapy was discontinued and the patient was started on an ACE inhibitor and beta-blocker. Abdominal ultrasound did not reveal any gallstones or common bile duct stones but a computerized tomography [CT] scan suggested uncomplicated acute alcoholic pancreatitis with pancreatic oedema and peripancreatic fat fullness. This was reasonably controlled with IV fluids and upgrading the diet gradually so that the patient was discharged over three days with no more lower abdominal pain. He was discharged on day five. Four weeks later he had mild improvement in his disability, although he complained of dyspnea following activities such as lifting weights or walking for a long distance. He no longer indulged in alcohol consumption again. He was advised to have another echo echocardiogram after three months but he never turned up.

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Figure 1. Show ECG of patient in different Lead.

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Figure 2. Show Echocardiogram of patient Left Ventricle.

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Figure 3. Pancreatic edema with surrounding fat stranding of the pancreas on abdominal CT.

3. Discussion

3.1. Clinical Presentation of Takotsubo Cardiomyopathy

Symptoms

a. Chest Pain: Patients often report sudden, severe chest pain, which is the most common presenting symptom. The pain is usually located in the center of the chest and can be described as a pressure or tightness

[10]

b. Dyspnea: Shortness of breath is frequently reported, often accompanying chest pain

[11]

c. Palpitations: Many patients experience irregular heartbeats or a sensation of a racing heart

[12]

d. Nausea and Vomiting: Gastrointestinal symptoms can also occur, contributing to the overall discomfort.

e. Syncope: Some patients may experience fainting or near-fainting episodes.

3.2. Physical Examination Findings of Cardiomyopathy

1. Physical Examination Findings

a. Vital Signs: Patients may present with tachycardia (increased heart rate) and hypotension (low blood pressure).

b. Signs of Heart Failure: In severe cases, signs of heart failure such as peripheral edema or jugular venous distention may be observed.

2. Electrocardiogram (ECG) Changes

a. ST-Segment Elevation: Many patients exhibit ST-segment elevation on the ECG, which can mimic an ST-elevation myocardial infarction (STEMI)

[13]

b. T-Wave Inversions: T-wave inversions are also common and can indicate myocardial ischemia.

3. Laboratory Findings

a. Elevated Cardiac Biomarkers: Cardiac enzymes such as troponin are often elevated, indicating myocardial injury.

b. B-Type Natriuretic Peptide (BNP): Levels may be elevated, reflecting heart strain.

4. Imaging Studies

a. Echocardiography: This is crucial for diagnosis, revealing characteristic left ventricular apical ballooning and regional wall motion abnormalities

[14]

b. Coronary Angiography: Typically shows no significant coronary artery disease, which helps differentiate TTC from myocardial infarction

[15]

5. Triggers

a. Emotional Stress: Many cases are precipitated by significant emotional stressors, such as the loss of a loved one or severe anxiety

[16]

b. Physical Stress: Physical events, such as surgery or severe illness, can also trigger TTC

[17]

Table 1. Clinical predictors for the diagnosis of Takotsubo syndrome.

Criteria	Points	Analysis Comments
Female sex	25	Most Weighted Criteria: Female sex has the highest points, highlighting its significance in diagnosing the syndrome.
Emotional trigger	24	Most Weighted Criteria: Emotional trigger also has high points, indicating its importance in diagnosis.
Physical trigger	13	-
Absence of ST-segment depression*	12	-
Psychiatric disorders	11	-
Neurological disorders	9	-
QTc prolongation	6	-
Total	100	Scoring System Purpose: Likely used to assess the probability of Takotsubo syndrome in patients.

*Note: Absence of ST-segment depression is considered except in lead aVR.

This table combines both the criteria and their analysis, providing a comprehensive overview of the scoring system and its implications.

4. Conclusion

Takotsubo cardiomyopathy is characterized by a unique clinical presentation that can closely resemble acute coronary syndrome. Recognizing the symptoms, understanding the triggers, and utilizing appropriate diagnostic tools are essential for timely and accurate diagnosis. The prognosis is generally favorable, with most patients experiencing recovery of cardiac function within weeks.

Abbreviations

BNP	B-Type Natriuretic Peptide
ECG	Electrocardiogram
TTC	Takotsubo Cardiomyopathy
CT	Computerized Tomography

Authors’ Contributions

The project was a collaborative effort involving several key contributors. Amirhossein Farahani, Yasin Salari Sabzevaran, and Hemeesh Tandel focused on data curation, ensuring the integrity and organization of the data, as well as developing the methodology and conducting thorough analysis. Aelaf Aseged Mammo and Gulnaz Bahtiyarova were instrumental in the conceptualization of the project, gathering necessary resources, and writing the original draft to articulate the findings effectively.

Conflict of Interest

Authors declare no competing conflict of interest.

References

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[2]	Singh B, Manita B, Suman F, Kumari N, Shiza ST, Samreen I, Shah S, Mokhtar SM, Patel U, Devi J, Reza RR, Mohamed KH, Ahmad S, Nasir H. A Systematic Review of COVID-19 Vaccine-Induced Takotsubo Cardiomyopathy: A 2023 Update. Cureus. 2023 Dec 11; 15(12): e50319. https://doi.org/10.7759/cureus.50319
[3]	Matta AG, Carrié D. Epidemiology, Pathophysiology, Diagnosis, and Principles of Management of Takotsubo Cardiomyopathy: A Review. Med Sci Monit. 2023 Mar 6; 29: e939020. https://doi.org/10.12659/MSM.939020
[4]	Chams S, El Sayegh S, Hamdon M, Kumar S, Kulairi Z. Zumba-induced Takotsubo cardiomyopathy: a case report. J Med Case Rep. 2018 Jun 10; 12(1): 160. https://doi.org/10.1186/s13256-018-1696-x
[5]	Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ; RETAKO Investigators. Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev. 2024 Jul; 29(4): 739-750. https://doi.org/10.1007/s10741-024-10401-1
[6]	Habib M, Aronson D. Thromboembolic Complications in Takotsubo Cardiomyopathy. Semin Thromb Hemost. 2024 Oct 8. Epub ahead of print. PMID: 39379040. https://doi.org/10.1055/s-0044-1791511
[7]	Desai R, Singh S, Patel U, Fong HK, Kaur VP, Varma Y, Madan D, Patel S, Mahuwala Z, Sachdeva R, Kumar G. Frequency of takotsubo cardiomyopathy in epilepsy-related hospitalizations among adults and its impact on in-hospital outcomes: A national standpoint. Int J Cardiol. 2020 Jan 15; 299: 67-70. https://doi.org/10.1016/j.ijcard.2019.07.034 Epub 2019 Jul 13. Erratum in: Int J Cardiol. 2020 Jun 1; 308: 12.
[8]	Garg N, Raavi L, Maheshwari S, Celik NB, Rastogi A, Garg P. Complex Presentation of Pheochromocytoma: Hypertensive Encephalopathy and Takotsubo-Like Cardiomyopathy in a Young Female. Am J Case Rep. 2024 Sep 8; 25: e944024. https://doi.org/10.12659/AJCR.94402
[9]	Scafa-Udriste A, Horodinschi RN, Babos M, Dinu B. Diagnostic challenges between takotsubo cardiomyopathy and acute myocardial infarction-where is the emergency?: a literature review. Int J Emerg Med. 2024 Feb 15; 17(1): 22. https://doi.org/10.1186/s12245-024-00595-4
[10]	Aparisi Á, Uribarri A. Takotsubo syndrome. Med Clin (Barc). 2020 Oct 23; 155(8): 347-355. English, Spanish. https://doi.org/10.1016/j.medcli.2020.04.023
[11]	Amin HZ, Amin LZ, Pradipta A. Takotsubo Cardiomyopathy: A Brief Review. J Med Life. 2020 Jan-Mar; 13(1): 3-7. https://doi.org/10.25122/jml-2018-0067
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[16]	Khan I, Atoot A. An unusual presentation of takotsubo syndrome in an elderly patient. Oxf Med Case Reports. 2024 Feb 16; 2024(2): omad144. https://doi.org/10.1093/omcr/omad144
[17]	Coons JC, Barnes M, Kusick K. Takotsubo cardiomyopathy. Am J Health Syst Pharm. 2009 Mar 15; 66(6): 562-6. https://doi.org/10.2146/ajhp080225

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APA Style

Mammo, A. A., Farahani, A., Sabzevaran, Y. S., Chavda, S. J., Singh, M., et al. (2025). Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. American Journal of Internal Medicine, 13(1), 1-6. https://doi.org/10.11648/j.ajim.20251301.11

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ACS Style

Mammo, A. A.; Farahani, A.; Sabzevaran, Y. S.; Chavda, S. J.; Singh, M., et al. Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. Am. J. Intern. Med. 2025, 13(1), 1-6. doi: 10.11648/j.ajim.20251301.11

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AMA Style

Mammo AA, Farahani A, Sabzevaran YS, Chavda SJ, Singh M, et al. Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. Am J Intern Med. 2025;13(1):1-6. doi: 10.11648/j.ajim.20251301.11

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@article{10.11648/j.ajim.20251301.11,
  author = {Aelaf Aseged Mammo and Amirhossein Farahani and Yasin Salari Sabzevaran and Sachi Jaydipsinh Chavda and Mirab Singh and Hemeesh Tandel and Zhang Ming},
  title = {Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult},
  journal = {American Journal of Internal Medicine},
  volume = {13},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ajim.20251301.11},
  url = {https://doi.org/10.11648/j.ajim.20251301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20251301.11},
  abstract = {Takotsubo cardiomyopathy (TTC), or "broken heart syndrome," is a transient cardiac condition marked by left ventricular dysfunction, often triggered by emotional or physical stress. This case report discusses a 28-year-old female who developed TTC after the sudden loss of a close family member. She presented to the emergency department with acute chest pain, dyspnea, and anxiety, resembling acute myocardial infarction. ECG showed ST-segment elevations and T-wave inversions, while lab tests revealed elevated cardiac biomarkers, including troponin. An echocardiogram confirmed classic apical ballooning, and coronary angiography ruled out obstructive coronary artery disease, showing normal arteries. The patient received supportive care, including beta-blockers and anxiolytics, and her symptoms improved, with follow-up echocardiography showing normal left ventricular function within weeks. This case highlights the need for awareness of TTC in younger patients under emotional stress and the importance of timely diagnosis and management to avoid unnecessary interventions.},
 year = {2025}
}

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TY  - JOUR
T1  - Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult
AU  - Aelaf Aseged Mammo
AU  - Amirhossein Farahani
AU  - Yasin Salari Sabzevaran
AU  - Sachi Jaydipsinh Chavda
AU  - Mirab Singh
AU  - Hemeesh Tandel
AU  - Zhang Ming
Y1  - 2025/01/17
PY  - 2025
N1  - https://doi.org/10.11648/j.ajim.20251301.11
DO  - 10.11648/j.ajim.20251301.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 1
EP  - 6
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20251301.11
AB  - Takotsubo cardiomyopathy (TTC), or "broken heart syndrome," is a transient cardiac condition marked by left ventricular dysfunction, often triggered by emotional or physical stress. This case report discusses a 28-year-old female who developed TTC after the sudden loss of a close family member. She presented to the emergency department with acute chest pain, dyspnea, and anxiety, resembling acute myocardial infarction. ECG showed ST-segment elevations and T-wave inversions, while lab tests revealed elevated cardiac biomarkers, including troponin. An echocardiogram confirmed classic apical ballooning, and coronary angiography ruled out obstructive coronary artery disease, showing normal arteries. The patient received supportive care, including beta-blockers and anxiolytics, and her symptoms improved, with follow-up echocardiography showing normal left ventricular function within weeks. This case highlights the need for awareness of TTC in younger patients under emotional stress and the importance of timely diagnosis and management to avoid unnecessary interventions.
VL  - 13
IS  - 1
ER  -

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Author Information

Aelaf Aseged Mammo

Wachemo University, College of Medicine, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia

Contact Email

http://orcid.org/0009-0009-2436-4849
Amirhossein Farahani

Xi’an Jiaotong University School of Medicine, Xi’an, China

Contact Email

http://orcid.org/0009-0009-6450-7832
Yasin Salari Sabzevaran

Xi’an Jiaotong University School of Medicine, Xi’an, China

Contact Email

http://orcid.org/0009-0008-8699-4021
Sachi Jaydipsinh Chavda

Gujarat Medical Education and Research Society Medical College and Hospital, Sola, Ahmedabad, Gujarat, India

Contact Email

http://orcid.org/0009-0004-7258-994X
Mirab Singh

Department of Emergency, Mediciti Hospital, Kathmandu, Nepal

Contact Email

http://orcid.org/0009-0001-5865-7422
Hemeesh Tandel

Chimanlal Ujamshibhai Shah Medical College, Saurashtra University, Surendranagar, Gujarat, India

Contact Email

http://orcid.org/0009-0008-5165-9493
Zhang Ming

Department of Internal Medicine, First Affiliated Hospital of Zhejiang University, Hangzhou, China

Contact Email

http://orcid.org/0009-0005-9494-3791

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Table 1

Table 1. Clinical predictors for the diagnosis of Takotsubo syndrome.

Plain Text BibTeX RIS

APA Style

Mammo, A. A., Farahani, A., Sabzevaran, Y. S., Chavda, S. J., Singh, M., et al. (2025). Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. American Journal of Internal Medicine, 13(1), 1-6. https://doi.org/10.11648/j.ajim.20251301.11

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ACS Style

Mammo, A. A.; Farahani, A.; Sabzevaran, Y. S.; Chavda, S. J.; Singh, M., et al. Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. Am. J. Intern. Med. 2025, 13(1), 1-6. doi: 10.11648/j.ajim.20251301.11

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AMA Style

Mammo AA, Farahani A, Sabzevaran YS, Chavda SJ, Singh M, et al. Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult. Am J Intern Med. 2025;13(1):1-6. doi: 10.11648/j.ajim.20251301.11

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@article{10.11648/j.ajim.20251301.11,
  author = {Aelaf Aseged Mammo and Amirhossein Farahani and Yasin Salari Sabzevaran and Sachi Jaydipsinh Chavda and Mirab Singh and Hemeesh Tandel and Zhang Ming},
  title = {Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult},
  journal = {American Journal of Internal Medicine},
  volume = {13},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ajim.20251301.11},
  url = {https://doi.org/10.11648/j.ajim.20251301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20251301.11},
  abstract = {Takotsubo cardiomyopathy (TTC), or "broken heart syndrome," is a transient cardiac condition marked by left ventricular dysfunction, often triggered by emotional or physical stress. This case report discusses a 28-year-old female who developed TTC after the sudden loss of a close family member. She presented to the emergency department with acute chest pain, dyspnea, and anxiety, resembling acute myocardial infarction. ECG showed ST-segment elevations and T-wave inversions, while lab tests revealed elevated cardiac biomarkers, including troponin. An echocardiogram confirmed classic apical ballooning, and coronary angiography ruled out obstructive coronary artery disease, showing normal arteries. The patient received supportive care, including beta-blockers and anxiolytics, and her symptoms improved, with follow-up echocardiography showing normal left ventricular function within weeks. This case highlights the need for awareness of TTC in younger patients under emotional stress and the importance of timely diagnosis and management to avoid unnecessary interventions.},
 year = {2025}
}

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TY  - JOUR
T1  - Emotional Turmoil: A Case of Takotsubo Cardiomyopathy in a Young Adult
AU  - Aelaf Aseged Mammo
AU  - Amirhossein Farahani
AU  - Yasin Salari Sabzevaran
AU  - Sachi Jaydipsinh Chavda
AU  - Mirab Singh
AU  - Hemeesh Tandel
AU  - Zhang Ming
Y1  - 2025/01/17
PY  - 2025
N1  - https://doi.org/10.11648/j.ajim.20251301.11
DO  - 10.11648/j.ajim.20251301.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 1
EP  - 6
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20251301.11
AB  - Takotsubo cardiomyopathy (TTC), or "broken heart syndrome," is a transient cardiac condition marked by left ventricular dysfunction, often triggered by emotional or physical stress. This case report discusses a 28-year-old female who developed TTC after the sudden loss of a close family member. She presented to the emergency department with acute chest pain, dyspnea, and anxiety, resembling acute myocardial infarction. ECG showed ST-segment elevations and T-wave inversions, while lab tests revealed elevated cardiac biomarkers, including troponin. An echocardiogram confirmed classic apical ballooning, and coronary angiography ruled out obstructive coronary artery disease, showing normal arteries. The patient received supportive care, including beta-blockers and anxiolytics, and her symptoms improved, with follow-up echocardiography showing normal left ventricular function within weeks. This case highlights the need for awareness of TTC in younger patients under emotional stress and the importance of timely diagnosis and management to avoid unnecessary interventions.
VL  - 13
IS  - 1
ER  -

Copy | Download