From Heartbreak to Heart Failure: Unravelling Takotsubo Cardiomyopathy Triggered by Infection

Abstract

Background: Takotsubo Cardiomyopathy (TTC), or “broken heart syndrome,” is a transient left ventricular dysfunction that mimics acute coronary syndrome (ACS) but occurs without obstructive coronary artery disease. While commonly associated with emotional or physical stress, infection-induced TTC remains underrecognized. Respiratory tract infections (RTI) have been increasingly reported as potential triggers, suggesting a role for systemic inflammation in TTC pathophysiology. Case: We present the case of an 80-year-old female with a history of hypertension, rheumatoid arthritis, and epilepsy, who developed acute dyspnea, palpitations, and chest discomfort. One week prior, she had been admitted with fever and cough, diagnosed with an RTI, with chest X-ray revealing right-sided pleural effusion. Given her symptoms and ECG findings of ST-segment elevation in leads II, III, aVF, and anterior precordial leads, STEMI was initially suspected. However, coronary angiography revealed no significant coronary artery stenosis. Laboratory findings showed elevated high-sensitivity troponin I (3976.2 ng/L) and Pro-BNP (2415 pg/mL), raising concerns for myocardial injury. Echocardiography confirmed left ventricular dysfunction (LVEF 45%), inferior and anterior septal hypokinesia, and characteristic apical ballooning, establishing the diagnosis of TTC. The patient was managed conservatively with heart failure therapy, including ARNI, beta-blockers, SGLT-2 inhibitors, and supportive care. Her condition stabilized, and she was transferred for continued treatment of the underlying infection. Conclusion: This case underscores the importance of recognizing infection-induced TTC, particularly in elderly patients presenting with ACS-like symptoms and non- obstructive coronary arteries. The pathophysiology may involve catecholamine surge, systemic inflammation, and microvascular dysfunction. Increased awareness of this rare but significant TTC trigger can improve diagnostic accuracy and prevent unnecessary invasive procedures. Further research is needed to better define the relationship between infections and TTC outcomes.