Role of Echocardiography in Managing a Rare Case of Reverse Takotsubo Cardiomyopathy Presenting as Cardiogenic Shock after Prolonged Hip Surgery

One of the major causes of reversible left ventricular (LV) systolic dysfunction is takotsubo cardiomyopathy. It is characterized by angina, dyspnea, electrocardiogram changes (ST segment elevation and T wave changes on chest leads of electrocardiogram), echocardiographic changes (LV dysfunction with predominant apical involvement), elevation of troponin and brain natriuretic peptide, usually mimicking acute coronary syndrome. Coronary angiogram in such cases is either normal or shows only insignificant coronary disease. Although LV apical involvement is the commonest manifestation, about one-fifth of cases of takotsubo cardiomyopathy have normal apical contractility but severe systolic dysfunction of the basal segments of the left ventricle. We report a case of reverse takotsubo cardiomyopathy developed in a relatively young patient following hip surgery and how three-dimensional and strain echocardiography clearly demonstrated the abnormality and aided the recovery of the patient.