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Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS

Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory

Ahmed Rashed, Mohamed Shokr, Ahmed Subahi, Fayez Siddiqui, Aziz Alkatib and Luis Afonso
Ochsner Journal September 2019, 19 (3) 256-259; DOI: https://doi.org/10.31486/toj.18.0027
Ahmed Rashed
1Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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Mohamed Shokr
1Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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Ahmed Subahi
2Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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  • For correspondence: asubahi{at}med.wayne.edu
Fayez Siddiqui
1Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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Aziz Alkatib
1Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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Luis Afonso
1Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
MD
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    Figure 1.

    Transthoracic echocardiogram from the patient's first presentation shows apical 2-chamber views of end diastole (left) and end systole (right) and reveals hypokinesis of left ventricular apical segments with hyperdynamic basal and mid segments.

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    Figure 2.

    Transthoracic echocardiogram from the patient's second presentation shows apical 4-chamber views of end diastole (left) and end systole (right) and reveals hypokinesis of the basal and mid left ventricular segments with spared apical contractility.

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    Figure 3.

    Peak systolic strain reveals attenuation of basal and mid segments with apical sparing. Echocardiographic strain and strain-rate imaging (deformation imaging) is a noninvasive method for assessing myocardial function that can differentiate between active and passive movement of myocardial segments to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable. This imaging modality allows comprehensive assessment of myocardial function.

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    Table.

    Anatomic Variants of Takotsubo Cardiomypathy2,6

    VariantEstimated Incidence
    Apical75%-82%
    Midventricular10%-15%
    Basal or inverted2%-5%
    Focal variant1.5%
    Other rare atypical variants:
     Biventricular apical variantUnknown
     Dysfunction sparing apical tipUnknown
     Isolated right ventricular variantUnknown
     Global variantsUnknown
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Ochsner Journal: 19 (3)
Ochsner Journal
Vol. 19, Issue 3
Sep 2019
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Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory
Ahmed Rashed, Mohamed Shokr, Ahmed Subahi, Fayez Siddiqui, Aziz Alkatib, Luis Afonso
Ochsner Journal Sep 2019, 19 (3) 256-259; DOI: 10.31486/toj.18.0027

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Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory
Ahmed Rashed, Mohamed Shokr, Ahmed Subahi, Fayez Siddiqui, Aziz Alkatib, Luis Afonso
Ochsner Journal Sep 2019, 19 (3) 256-259; DOI: 10.31486/toj.18.0027
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