Typical and atypical Takotsubo syndrome in the same patient.

Takotsubo syndrome (TTS) usually affects post-menopausal women and is characterized by the abrupt onset of acute chest symptoms, usually precipitated by physical or psychological stress, angiographic absence of occlusive coronary artery disease and transient left ventricular (LV) dysfunction, typically involving the apical to mid-ventricle with compensatory hyperkinesis of the basal segments. Recently, different morphologic variants have been described. Although the exact mechanism responsible for this entity has yet to be clarified, a stress induced surge in catecholamines, causing myocardial stunning, is the currently proposed hypothesis [4]. Recurrence of TTS seems to be rare and has been documented to occur in less than 10% of the patients, typically within 4 years. We report an unusual case of a post-menopausal woman admitted for typical TTS who subsequently presented with a recurrence mid-ventricular TTS variant after 6 years triggered by emotional stress. The potential pathophysiologic mechanism responsible for recurrent TTS presenting with different morphologic patterns is discussed.