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REVERSE TAKOTSUBO CARDIOMYOPATHY IN AN
ELDERLY PATIENT WITH BACTEREMIA
Capt Debra Koenigsberger, USAF, MC David Grant Medical Center, Travis AFB, CA
INTRODUCTION
Reverse takotsubo cardiomyopathy (RTCM):
• Subtype of stress cardiomyopathy
• Transient hyperdynamic apex with akinetic
base
• Typically affects the young and healthy
• Associated with exogenous catecholamine
exposure
• Often presents w/ anginal chest pain and
dyspnea
• Troponin elevation often noted
• ST elevation on EKG often seen
• Normal coronary arteries on cardiac cath
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PATIENT CASE
67 yo F with metastatic breast cancer
Neutropenic fever, MSSA bacteremia
Dyspnea, tachycardia, high BP on HD #2
No chest pain
EKG with ST-elevation, troponin 0.78
Cardiac cath:
• No acute thrombus or vasospasm
• Anterior and inferior hypokinetic base
• EF of 45%
Cardiac cath showing normal filling
pattern during diastole
DISCUSSION
RTCM incidence increasing in literature with
atypical features:
• Advanced age
• Subtle symptoms
• Endogenous hyperadrenergic state
Important to consider in critically ill patients:
• Prevent unnecessary fluid boluses
• Optimize medical therapy
• Ensure proper monitoring
• Tailor medications to prevent torsades
CONCLUSION
Hyperdynamic apex during systole
Classic takotsubo cardiomyopathy:
hyperdynamic base, apical ballooning
• Patient’s symptoms resolved and EF
normalized on repeat echo 24 hours later
• Outpatient medications optimized for
continued treatment of cardiomyopathy
• RTCM can present atypically and subtly in
older patients
• Early recognition facilitates targeted
management of heart failure and
cardiogenic shock
"The views expressed in this material are those of the authors, and do not reflect the official policy or
position of the U.S. Government, the Department of Defense or the Department of the Air Force."