# Atypical Stress Cardiomyopathy and the Need for Multidisciplinary Care

## TL;DR

A rare heart condition called reverse takotsubo cardiomyopathy was diagnosed in a young woman during childbirth, highlighting the importance of coordinated care between cardiology and obstetric teams.

## Contribution

This case emphasizes the need for multidisciplinary collaboration in managing atypical stress cardiomyopathy during pregnancy.

## Key findings

- Reverse takotsubo cardiomyopathy was diagnosed based on echocardiographic and ventriculographic findings.
- Conservative management with beta-blockers was effective in this patient's recovery.
- Collaboration between cardiology and obstetric teams is crucial for optimal maternal and fetal outcomes.

## Abstract

Reverse takotsubo cardiomyopathy is a rare variant of the classic stress-induced takotsubo cardiomyopathy. It is associated with transient left ventricular (LV) systolic dysfunction characterized by basal hypokinesis and apical hyperkinesis. We present a case of a 27-year-old woman who presented to an outside facility for a scheduled cesarean section and developed perioperative chest tightness, hypoxemia, and hypotension. Her electrocardiogram (ECG) showed sinus rhythm with marked ST segment depressions in leads V4-V6. High sensitivity troponin was elevated to 474 ng/L. Transthoracic echocardiography revealed an LV ejection fraction of 52% (Simpson's) with hypokinesis of the basal myocardial segments and hyperdynamic systolic function of the apical segments. Subsequent coronary angiography showed angiographically normal epicardial coronaries. Left ventriculography showed ballooning of the basal segments with apical hyperkinesis. She was subsequently diagnosed with reverse takotsubo cardiomyopathy and managed conservatively with beta-blockers. In this case, we highlight the need for collaboration between the cardiology and obstetric teams for tailored management strategies to ensure the well-being of both mother and baby.