Abstract 4363503: Reverse Takotsubo Cardiomyopathy Triggered by Acute Pancreatitis: Rare Stress-Induced Cardiac Syndrome

Abstract

Introduction: Takotsubo cardiomyopathy is an uncommon condition characterized by transient regional systolic dysfunction, which can mimic an acute myocardial infarction in the absence of coronary artery obstruction, typically in response to stress-induced states. An even rarer variant is reverse Takotsubo, which presents with basal akinesis and apical hyperkinesis. We present a rare case of reverse Takotsubo in a young female that is believed to be triggered by acute pancreatitis. Case Presentation: A 48-year-old female with a past medical history of hypertension presented with acute abdominal pain and an elevated lipase of 512, leading to a diagnosis of acute pancreatitis. On the second day of hospitalization, laboratory studies showed marked elevation of troponin levels from 47.8 to 10,601 ng/l, although the patient remained asymptomatic from a cardiac standpoint. Electrocardiogram demonstrated no ischemic changes, and coronary angiography ruled out obstructive coronary artery disease. A transthoracic echocardiogram revealed left ventricular ejection fraction (EF) of 45–50% and global hypokinesis with sparing of the left ventricle (LV) apex, consistent with reverse Takotsubo cardiomyopathy. The etiology was suspected to be physiologic stress induced by acute pancreatitis. Common causes of pancreatitis were excluded, however the patient was recently started semaglutide, making this the most likely precipitating factor at the time. She was treated conservatively with guideline-directed medical therapy for stage B heart failure, including beta-blockers and angiotensin receptor blockers. A follow-up echocardiogram performed two months later revealed normalization of LVEF and resolution of wall motion abnormalities. Discussion: Reverse Takotsubo cardiomyopathy is a rare variant of stress cardiomyopathy that predominantly affects younger females and is often triggered by physical stressors like acute illness. While the exact pathophysiology remains unclear, proposed mechanisms include catecholamine-induced myocardial stunning or inflammation-mediated injury. Recognizing the association between stress-inducing conditions like acute pancreatitis and this uncommon cardiac presentation is essential for facilitating timely diagnosis and appropriate management.