CTICasesReverse Takotsubo Cardiomyopathy
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Imaging findings
A 40-year-old female presented with chest pain, nausea, vomiting, a non-ST elevation myocardial infarction, and troponin leak. Echocardiography showed an ejection fraction (EF) of approximately 30%. Cardiac MRI revealed no delayed enhancement. Contraction was preserved in the apex and mid-ventricle, but significantly reduced (hypokinetic) in the basal segments.
Key takeaways
This case represents reverse or inverted Takotsubo cardiomyopathy, characterized by preserved apical contraction but basal hypokinesis, the opposite of typical Takotsubo. This pattern is often observed in younger patients due to a higher concentration of adrenergic receptors in the base of the heart, making it more susceptible to catecholamine surges during stress. It is also seen in 'neurogenic stunned myocardium' following cerebral hemorrhages. The patient's EF subsequently normalized, confirming its transient nature.
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