Apical ballooning (Takotsubo) syndrome in the setting of chronic alcohol-induced hyponatremia

 Takotsubo cardiomyopathy is also known as stress induced cardiomyopathy and transient left ventricular apical ballooning syndrome. There have been few case reports where hyponatremia was implicated as a trigger for stress-induced cardiomyopathy. We report the unusual case of a 79-year-old African American woman without any discernible recent stressors who presented atypically with generalized fatigue and was found to have severe hyponatremia (from chronic alcohol use and thiazide diuretics) and significantly elevated Troponin. Her echocardiogram and cardiac catheterization revealed typical features of apical ballooning syndrome.