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Case report
‘Tax-otsubo’: stress cardiomyopathy following an encounter with the Inland Revenue
  1. Myles William Roach and
  2. Peter Currie
  1. Cardiovascular Department, Arrowe Park Hospital, Wirral, UK
  1. Correspondence to Dr Peter Currie; petercurrie{at}


An 89-year-old man developed chest pain and palpitations shortly after finishing a stressful 40 min phone call to HM Revenue and Customs. After admission to the emergency department, he had a cardiovascular collapse followed soon after by a cardiac arrest due to ventricular fibrillation (VF). The troponin T was elevated and his ECG showed extensive deep T wave inversion with prolongation of the QT interval. A portable hand-held ultrasound device (VScan; GE Healthcare) was used to demonstrate classical apical ballooning of the left ventricular apex indicating a diagnosis of takotsubo stress cardiomyopathy. Shortly following admission to the cardiac care unit, he had a further episode of VF, which was successfully defibrillated. A coronary angiogram was performed, which was normal. He was treated with a short course of benzodiazepines. He was discharged after 8 days without any neurological deficit. His echocardiogram subsequently showed complete resolution of the abnormalities of the left ventricular function.

  • heart failure
  • arrhythmias
  • clinical diagnostic tests

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  • Contributors PC was the lead consultant in care of the patient when admitted and who made the diagnosis of takotsubo cardiomyopathy. It was suggested by MWR for this to be published as a case report. MWR did the initial drafting as well as 3, 5, 7 and final. PC added to the initial drafting and subsequently drafted versions 4, 6 and 8 and addressed the reviewers' comments.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.