Skip to main content

An uncommon manifestation of shock: Takotsubo syndrome


76-year-old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram that showed mild coronary artery disease. Left ventriculogram was performed, which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of Takotsubo syndrome. Echocardiogram confirmed the presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient. She was initiated on medical heart failure therapy and improved. Follow-up investigations after 2 months showed complete resolution of systolic dysfunction and symptoms.


  1. Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, et al. 2016 Current state of knowledge on Takotsubo syndrome: a position statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure 18 8–27. (doi:10.1002/ejhf.424)

    Article  Google Scholar 

  2. Ramaraj R, Movahed MR 2010 Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congestive Heart Failure 16 284–286. (doi:10.1111/j.1751-7133.2010.00188.x)

    Article  Google Scholar 

  3. Citro R, Lyon AR, Meimoun P, Omerovic E, Redfors B, Buck T, Lerakis S, Parodi G, Silverio A, Eitel I, et al. 2015 Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications. Journal of the American Society of Echocardiography 28 57–74. (doi:10.1016/j.echo.2014.08.020)

    Article  Google Scholar 

  4. Kazakauskaitė E, Jankauskas A, Lapinskas T, Ordienė R, Ereminienė E 2014 Takotsubo cardiomyopathy: the challenging diagnosis in clinical routine. Medicina 50 1–7. (doi:10.1016/j.medici.2014.05.009)

    Article  Google Scholar 

  5. Citro R, Rigo F, D’Andrea A, Ciampi Q, Parodi G, Provenza G, Piccolo R, Mirra M, Zito C, Giudice R, et al. 2014 Echocardiographic correlates of acute heart failure, cardiogenic shock, and in-hospital mortality in Takotsubo cardiomyopathy. JACC: Cardiovascular Imaging 7 119–129. (doi:10.1016/j.jcmg.2013.09.020)

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ying X. Gue MBChB MRCP.

Additional information

Author contribution statement Y X G drafted the case presentation, investigations and treatment. S S B assisted with initial corrections and discussion. M A was the consultant in charge of the patient’s care.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gue, Y.X., Bhandari, S.S. & Ahamed, M. An uncommon manifestation of shock: Takotsubo syndrome. Echo Res Pract 4, K41–K45 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key Words