Young Female with a Fragile Heart: A Rare Case of Reverse Takotsubo Cardiomyopathy

Abstract

Reverse Takotsubo cardiomyopathy (rTTC) is an uncommon and atypical variant of stress-induced cardiomyopathy, distinguished by transient basal left ventricular (LV) ballooning. Its clinical presentation often mimics acute coronary syndrome (ACS), making diagnosis particularly challenging. We report the case of a young female who presented with vomiting, apprehension, and dyspnea, which rapidly progressed to cardiogenic shock. Initial electrocardiogram (ECG) and echocardiography findings suggested ACS or myocarditis. The patient was managed with inotropes, diuretics, supplemental oxygen, and mechanical ventilation. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of rTTC, revealing basal hypokinesia, myocardial edema, apical sparing, and the absence of late gadolinium enhancement (LGE). Her cardiac function normalized by day five, and she was discharged in a stable condition. This case underscores the diagnostic complexity, clinical reversibility, and favorable recovery trajectory of rTTC, particularly in atypical presentations among young females.