Frequently Recurrent Takotsubo Syndrome in COPD

Table 2

Clinical presentation of a 70-year-old female COPD patient with recurrent TTS.

	FMC	32 months after FMC	40 months after FMC	40.5 months after FMC	46 months after FMC	48 months after FMC
Symptoms	Severe dyspnea	Dyspnea, exhaustion	Severe dyspnea, cough	Dyspnea, chest pain	Severe dyspnea	Dyspnea
ECG (Figure 1)	T-wave inversion	T-wave inversion	T-wave inversion	Mainly normal	T-wave inversion	Mainly normal
TPNT (ng/L)	53-108-54-14	58-288-285-88	19-200-300-240-54	107-112-52	31-431-521-574-51	42-74-107
NT-pro-BNP (pg/mL)	Normal	2088	1000	Normal	Normal	Normal
CT scan or CR	Normal	Normal	Bilateral pleural effusion	Normal	Normal	Normal
Coronary angiography	Normal	Normal	Normal	None	None	None
ECHO	Normal LVEF 60%	Hypokinesia in the septum and inferolateral wall. LVEF 30%	Global hypokinesia (partially preserved function in the basal wall). LVEF 20%	Normal	Midventricular akinesia but less affected function in apical and basal segments LVEF < 20%	None
ECHO (reviewed images)	Discrete apical hypokinesia	Severe hypokinesia, most prominent midventricular	Severe hypokinesia, most prominent midventricular and apical	Further analysis not possible due poor image quality	As above	None
Days at hospital	7	4	16	5	7	1
Initial diagnose	Myocarditis	Non-Q-wave MI	Myocarditis	Chest pain (UNS)	Midventricular TTC	Dyspnea (UNS)
Diagnose (after review)	Possible TTC	Midventricular TTC	Midventricular TTC	Unclear	Midventricular TTC	Unclear
Follow-up	ECHO: normal	CMR: normal; ECHO: normal	ECHO: normal	ECHO: normal	ECHO: normal LVEF; Minor basal hypokinesia	CCTA: no significant stenosis

CCTA: cardiac computed tomography angiography; CMR: cardiac magnetic resonance imaging; COPD: chronic obstructive pulmonary disease; CR: chest radiography; ECG: electrocardiogram; ECHO: echocardiography; FMC: first medical contact; LVEF: left ventricular ejection fraction; MI: myocardial infarction; NT-pro-BNP: NT-probrain natriuretic peptide; TPNT: troponin T; TTS: Takotsubo syndrome; UNS: unspecified.