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Recurrent biventricular takotsubo cardiomyopathy with fatal outcome
  1. Abdul-Fatawu Osman1,
  2. Si Yuan Khor2,
  3. Basel Abdelazeem3 and
  4. Waseem Barham4
  1. 1Internal Medicine, Michigan State University, East Lansing, Michigan, USA
  2. 2Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  3. 3Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA
  4. 4Department of Cardiology, Michigan State University, East Lansing, Michigan, USA
  1. Correspondence to Dr Abdul-Fatawu Osman; abdulfatawu01{at}


A woman in her 60s presented initially with nausea, vomiting and abdominal pain. She rapidly progressed to respiratory failure requiring intubation. ECG demonstrated no significant ST segment changes. Troponin I and brain natriuretic peptide were elevated. Chest CT angiography demonstrated small non-occlusive segmental pulmonary emboli. Transthoracic echocardiogram findings suggested biventricular takotsubo cardiomyopathy (TCM) with left ventricular ejection fraction of less than 20%. She improved with aggressive management and was discharged on carvedilol, lisinopril, atorvastatin and apixaban. Follow-up echocardiogram revealed complete resolution of the left and right ventricular wall motion abnormalities at 9 weeks. She had symptoms recurrence after 7 months from the initial presentation. Repeated echocardiogram was consistent with biventricular TCM recurrence. Despite aggressive medical therapy, multiorgan failure developed and patient care was later transitioned to palliative care.

  • Cardiovascular medicine
  • Heart failure
  • Radiology (diagnostics)

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  • Contributors A-FO wrote the case presentation and discussion. SYK wrote the abstract and contributed to case discussion. BA provided edits on case presentation and contributed to background or introduction. WB provided corrections and final edits.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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