---
title: "Reverse Takotsubo Cardiomyopathy in Respiratory Failure: A Case Report and Clinical Implications"
id: "pubmed-42687350"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42687350"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42687350/"
doi: "10.12659/AJCR.952896"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Reverse Takotsubo Cardiomyopathy in Respiratory Failure: A Case Report and Clinical Implications
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42687350
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42687350/)
- **DOI:** [10.12659/AJCR.952896](https://doi.org/10.12659%2FAJCR.952896)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A 69-year-old woman with prior coronary artery disease (status post left anterior descending artery stent), hypertension, hyperlipidemia, and chronic obstructive pulmonary disease presented in severe respiratory distress and became unresponsive, requiring emergency intubation. - She tested positive for coronavirus OC43 and was managed in the intensive care unit for a COPD exacerbation with **ventilator-dependent respiratory failure**. - Initial high-sensitivity troponin rose from 56 ng/L to 937 ng/L and subsequently peaked at 1928 ng/L after catheterization; electrocardiogram showed ST-T changes prompting cardiac evaluation. - Transthoracic echocardiography identified new segmental wall motion abnormalities and an estimated **ejection fraction** of 40%. - Urgent coronary angiography revealed no obstructive coronary disease and a patent LAD stent; left ventriculography demonstrated severe **basal hypokinesis** with preserved apical contraction, confirming **reverse takotsubo cardiomyopathy**. - Further history disclosed ongoing grief related to the patient’s sister’s death 3 months earlier; authors note emotional stressors may be chronic rather than abrupt in such cases. - The case emphasizes that **reverse takotsubo** can present like acute coronary syndrome during acute critical illness (including respiratory failure), and recognition of basal hypokinesis with apical preservation can prevent misdiagnosis and support appropriate supportive care and follow-up imaging. - Source data are derived from a published case report; no additional outcomes, long-term follow-up details, or specific therapeutic regimens beyond supportive management were reported in the abstract.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Hackensack Meridian School of Medicine, Nutley, NJ, USA. * 2 Department of Internal Medicine, Ocean University Medical Center, Brick, NJ, USA. * 3 Division of Cardiovascular Medicine-EP Section, SUNY Downstate Health Sciences University, Brooklyn, NY, USA. * PMID: **42687350** * DOI: [ 10.12659/AJCR.952896 ](https://doi.org/10.12659/ajcr.952896) Item in Clipboard Case Reports # When Grief Strains the Heart: A Case of Reverse Takotsubo Cardiomyopathy Triggered by Mourning and Respiratory Failure Peter Cwalina et al. Am J Case Rep. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Case Rep Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Case+Rep%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Case+Rep%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42687350/) . 2026 Sep 3:27:e952896. doi: 10.12659/AJCR.952896. ### Authors [Peter Cwalina](https://pubmed.ncbi.nlm.nih.gov/?term=Cwalina+P&cauthor_id=42687350)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687350/#short-view-affiliation-1 "Hackensack Meridian School of Medicine, Nutley, NJ, USA."), [Ibrahim Rahmatullah](https://pubmed.ncbi.nlm.nih.gov/?term=Rahmatullah+I&cauthor_id=42687350)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687350/#short-view-affiliation-2 "Department of Internal Medicine, Ocean University Medical Center, Brick, NJ, USA."), [Ayesha Samad](https://pubmed.ncbi.nlm.nih.gov/?term=Samad+A&cauthor_id=42687350)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687350/#short-view-affiliation-2 "Department of Internal Medicine, Ocean University Medical Center, Brick, NJ, USA."), [Adam S Budzikowski](https://pubmed.ncbi.nlm.nih.gov/?term=Budzikowski+AS&cauthor_id=42687350)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42687350/#short-view-affiliation-3 "Division of Cardiovascular Medicine-EP Section, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.") ### Affiliations * 1 Hackensack Meridian School of Medicine, Nutley, NJ, USA. * 2 Department of Internal Medicine, Ocean University Medical Center, Brick, NJ, USA. * 3 Division of Cardiovascular Medicine-EP Section, SUNY Downstate Health Sciences University, Brooklyn, NY, USA. * PMID: **42687350** * DOI: [ 10.12659/AJCR.952896 ](https://doi.org/10.12659/ajcr.952896) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract BACKGROUND Takotsubo cardiomyopathy is a transient stress-induced cardiomyopathy that can mimic acute coronary syndrome (ACS) but typically occurs without obstructive coronary disease. Reverse takotsubo is an uncommon variant characterized by basal hypokinesis with preserved apical contraction. We report an atypical case in which acute respiratory failure, rather than an abrupt emotional stressor, appeared to be the primary trigger. CASE REPORT A 69-year-old woman with coronary artery disease status after prior left anterior descending artery stent, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD) presented with severe respiratory distress and became unresponsive, requiring emergency intubation. She tested positive for coronavirus OC43 and was managed in the intensive care unit (ICU) for COPD exacerbation with ventilator-dependent respiratory failure. High-sensitivity troponin rose from 56 ng/L to 937 ng/L initially, later peaking at 1928 ng/L after catheterization with ST-T changes on EKG, prompting cardiac evaluation. Transthoracic echocardiography revealed new segmental wall motion abnormalities consistent with stress cardiomyopathy and an estimated ejection fraction of 40%. Urgent coronary angiography demonstrated no obstructive coronary disease with a patent LAD stent; left ventriculography showed severe basal hypokinesis with preserved apical contraction, confirming reverse takotsubo. Further history-taking revealed ongoing grief after her sister's death 3 months earlier. CONCLUSIONS Reverse takotsubo should be considered in patients with ACS-like presentations during acute critical illness, including respiratory failure, even when emotional stressors are chronic rather than sudden. Recognizing basal hypokinesis with preserved apical function can help avoid misdiagnosis and guide appropriate supportive management and follow-up imaging. 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