The fifth takotsubo variant

We document the fifth pattern of takotsubo cardiomyopathy, in which the mid-LV is hyperdynamic but the apex and base are akinetic or hypokinetic. This is a reverse mid-ventricular takotsubo. The patient is a 79-year-old woman admitted with chest pain and initially a normal EKG. Her troponin I rose to 5.4g/L (0.02-0.03g/L) and she developed QT prolongation and widespread T-wave inversion. Coronary angiography showed only very mild atheroma. Follow-up echocardiogram six weeks later showed normal left ventricular function.