takotsubo ( stress - induced ) cardiomyopathy ( tcm ) is also known as transient left ventricular ( lv ) apical ballooning or broken heart syndrome.1 this condition mimics the signs and symptoms of acute coronary syndrome without angiographic stenosis or spasm and appears in shape as a japanese octopus fishing pot called  takotsubo  in the systolic phase of ventriculography.2 , 3 we report a postmenopausal woman who experienced two episodes of tcm within 4 months of her initial presentation . for the purposes of exclusion of acute coronary syndrome , she was evaluated with multi - detector computed tomography ( mdct ) on her second admission . a 58-year - old woman with a history of tcm was admitted to the emergency department due to severe dyspnea accompanied by a sudden - onset , prolonged , burning chest pain and palpitation , similar to those she had experienced in her initial admission , while she was on -blocker . the occurrence and recurrence of tcm were triggered by emotional and physical stress ( anger and prolonged dancing at a wedding ceremony ) , respectively . at the time , transthoracic echocardiography had revealed akinesia of the lv , with the exception of the basal regions , and in addition , cardiac catheterization had demonstrated minimal coronary artery disease and follow - up transthoracic echocardiography had shown normalization of the lv wall motion abnormalities ( ejection fraction = 60% ) . this time on arrival , the patient had a blood pressure of 120/80 mmhg , pulse rate of 117 beats per minute , and respiratory rate of 35 breaths / minute . the admission surface electrocardiogram ( ecg ) showed sinus tachycardia , slight st elevation in v1 through v4 with shallow inverted t waves , and slow r progression ( figure 1a ) . although the patient s symptoms subsided to a great extent on the first day of admission , serial ecgs showed marked dynamic changes : deeply inverted t waves were formed and qt intervals became significantly prolonged ( figures 1b and 1c ) . transthoracic echocardiography on admission revealed a normal lv size with severe lv systolic dysfunction ( ejection fraction = 2025% ) and akinesia of the lv with the exception of the basal regions . the serum levels of ck - mb and high sensitive troponin t were 6.32 ng / ml ( reference range for females < 3.77 ng / ml ) and 213.8 ng / l ( reference range < 14 ng / l ) . clinical presentation , compatible tcm past history , and paraclinical findings were all in favor of this diagnosis . given her previous normal cardiac - catheterization , conducted five months previously , coronary arteries were evaluated via a less invasive procedure , namely mdct , which revealed no significant findings in the epicardial coronary arteries ( figure 2 ) . the patient s hospital course was uneventful , and she was discharged in good condition on hospital day 9 . on the follow - up visit , 3 months later , she was symptom free and all of the ecg ( figure 1d ) and transthoracic echocardiography abnormalities were almost completely resolved . tcm is a clinical syndrome of transient lv apical wall motion abnormality with relative preservation of the basal heart segments in the absence of any significant atherosclerotic disease.4 , 5 recurrent tcm has been reported from 2.7% to 11.4% of patients in case series,1 , 6 and time - to - recurrence ranges from 3 months to 13 years after the initial presentation.6 because of the similarity between tcm and acute coronary syndrome , urgent cardiac catheterization is encouraged ; or at least during the chronic stage , it is essential for the diagnosis of this syndrome . the prognosis of this syndrome is generally excellent , so noninvasive diagnosis is highly recommended.7 in patients with normal vasculature , a good negative predictive value has been reported for mdct in excluding the disease.7 it can be concluded that mdct may be a safer method for confirming the presence or absence of a significant stenotic lesion.7 on the other hand , there are studies highlighting the usefulness of cardiac magnetic resonance imaging ( cmr ) in evaluating myocardial viability and prognosis in tcm.7 , 8 it should be noted , however , that although cmr can be performed noninvasively , it is not recommended for urgent assessment inasmuch as it requires a long duration of scanning . therefore , it seems that mdct may be a valuable and safe diagnostic tool in the discrimination of tcm from acute coronary syndrome , especially in patients with suspicion of recurrent tcm who are evaluated via catheterization in their initial admission within a short period of time . mdct may be a useful noninvasive cardiac imaging technique for the exclusion of acute coronary syndrome without important complications in postmenopausal women presenting with anterior chest pain , history of recent emotional or physical stress , relatively few coronary risk factors , and with typical lv dysfunction of tcm .
takotsubo cardiomyopathy ( tcm ) , also known as stress - induced cardiomyopathy , is a clinical syndrome of transient left ventricular ( lv ) apical wall motion abnormality with relative preservation of the basal heart segments in the absence of any significant atherosclerosis . 
 recurrence of this condition is rare . 
 we report a postmenopausal woman , who experienced two episodes of tcm within 4 months following emotional and physical stress . in the first episode 
 , she was admitted due to severe dyspnea , accompanied by sudden - onset , prolonged , burning chest pain and palpitation . 
 transthoracic echocardiography revealed akinesia of the lv , with the exception of the basal regions . 
 coronary angiography demonstrated no significant coronary artery disease , and follow - up echocardiography showed normalization of the lv wall motion abnormalities . in the second episode , she experienced similar symptoms and echocardiography revealed similar changes . multi - detector computed tomography revealed normal coronary arteries . 
 after 9 days , she was discharged in good condition ; and at 3 months follow - up , she was symptom - free with normal echocardiography .