Takotsubo Cardiomyopathy With Markedly Elevated Troponin Triggered by Acute Psychosis: A Case Report

TL;DR

A 38-year-old woman with acute psychosis and no heart symptoms had a rare case of takotsubo cardiomyopathy with extremely high troponin levels, highlighting the need for careful diagnosis in psychiatric patients.

Contribution

Reports a rare case of takotsubo cardiomyopathy with unusually high troponin levels triggered by acute psychosis.

Findings

The patient had troponin I levels over 24,000 ng/L, which is atypical for takotsubo cardiomyopathy.

Multimodal imaging confirmed takotsubo cardiomyopathy with unobstructed coronary arteries.

Conservative treatment and psychiatric care led to recovery of heart function.

Abstract

Takotsubo cardiomyopathy (TTC) is an acute, reversible form of left ventricular dysfunction that mimics acute coronary syndrome (ACS), typically presenting with modest troponin elevation. We report a 38-year-old woman with a history of depression, who presented with acute psychosis requiring haloperidol sedation. Routine ECG monitoring revealed inferolateral ST-segment elevation, although she was asymptomatic at presentation and recalled only a non-specific burning chest discomfort three days prior. Laboratory tests demonstrated markedly elevated troponin I (>24,000 ng/L) and creatine kinase (5,931 U/L), unusual for TTC and suggestive of ACS. Bedside echocardiography revealed severe left ventricular systolic dysfunction with apical akinesia (ejection fraction (EF) ~35%), while coronary CT angiography showed unobstructed coronary arteries and a zero calcium score, confirming TTC. She was managed conservatively in the coronary care unit with bisoprolol and dapagliflozin, and psychiatric input guided safe antipsychotic use. Follow-up echocardiography demonstrated improvement in left ventricular function (EF 45%-49%), with resolution of symptoms.

This case highlights the rare occurrence of TTC with disproportionately high troponin levels and underscores the importance of multimodal imaging and multidisciplinary management in patients with psychiatric comorbidities to avoid misdiagnosis and unnecessary invasive procedures.

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