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Requests for reprints should be addressed to Olivia Hung, MD, PhD, Sarver Heart Center, Department of Medicine, The University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724.
The patient is a postmenopausal female in her mid-50s with a reported history of Crohn's
disease who presented on 3 separate occasions with gastrointestinal symptoms that
progressed to chest pain with elevated troponin and wall motion abnormalities on transthoracic
echocardiogram. High-sensitivity troponin peak, leukocyte count, inflammatory markers,
and echocardiographic description for each episode are presented in the Figure. During the first episode, she additionally developed respiratory failure. The transthoracic
echocardiogram demonstrated a left ventricular ejection fraction of 20% with apical
hypokinesis and basal sparing, consistent with classic takotsubo cardiomyopathy. She
underwent urgent coronary angiography showing no occlusive disease or plaque rupture.
She was started on lisinopril for heart failure. At follow-up, echocardiogram demonstrated
normal left ventricular ejection fraction and wall motion, and her heart failure medications
were discontinued.
