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Intraoperative “Broken Heart” Cardiomyopathy with an “Inverted” Takotsubo Pattern

Michael Ruisi, James Lee and Maurice Rachko

Takotsubo cardiomyopathy is a reversible form of acute heart failure first described in Japan, believed to be triggered by major stressful events in a patient’s life. The patient’s clinical presentation in conjunction with ECG analysis, echocardiography, and angiography depicts an ischemic event leading to LV dysfunction with no evidence of an acute coronary syndrome. Classically, the cardiomyopathy manifests itself as apical akinesis and ballooning on echocardiography mimicking the likeness of an octopus trap. Less commonly there have been reports of an inverted pattern type of Takotsubo cardiomyopathy with preserved apical wall function. We present the case of a 43 year old female who developed a transient inverted variant of Takotsubu cardiomyopathy during an elective herniorrhaphy. A postoperative transthoracic echocardiogram revealed severely reduced LV function with akinesis of the basal and posterior walls with severe mitral regurgitation. Cardiac catheterization failed to reveal significant lesions, and an intra-aortic balloon pump was placed for cardiac support. Over the next 5 days the patient’s clinical picture improved markedly with complete normalization of LV function.