An uncommon manifestation of shock: Takotsubo syndrome

76-year-old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram that showed mild coronary artery disease. Left ventriculogram was performed, which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of Takotsubo syndrome. Echocardiogram confirmed the presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient. She was initiated on medical heart failure therapy and improved. Follow-up investigations after 2 months showed complete resolution of systolic dysfunction and symptoms. LEARNING POINTS: Takotsubo syndrome can present similarly to ACS. Early use of echocardiography in the acute setting can provide vital information. Takotsubo syndrome can result in hemodynamic instability requiring urgent interventions. Other investigative modalities can be used in conjunction with echocardiography to confirm the diagnosis of Takotsubo syndrome. Prognosis is generally good in patients with Takotsubo syndrome.