Stress-Induced Cardiomyopathy Raising Concern for Myocardial Ischemia

Stress-induced cardiomyopathy (SIC), or Takotsubo syndrome, is considered a reversible dysfunction of the left ventricle that may mimic an acute coronary syndrome (ACS). Patients may present with chest pain, dyspnea, syncope, or other serious complications including cardiogenic shock, ventricular arrhythmias, and thrombus formation. Diagnostic criteria for SIC include several factors, including electrocardiogram changes, cardiac biomarker elevations, ventricular regional wall abnormalities on echocardiogram, and absence of occlusive coronary disease on coronary angiography. There is no standardized protocol for the treatment of SIC, although the current consensus is that patients should be risk-stratified, managed for complications, and treated with supportive therapy accordingly. In this case study, we present an 85-year-old female who presented with one month of fatigue, lower extremity weakness, and exertional dyspnea with chest pressure. She received a cardiac workup which revealed lab and imaging findings consistent with SIC. She received treatment for SIC, pericarditis, and Clostridium difficile colitis.