title: Recurrent takotsubo cardiomyopathy : variable pattern of ventricular involvement.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theories have been proposed without concrete evidence.
  
  
  METHODS
  We present a case series of 3 patients with recurrent TTC involving a different region of the ventricle during recurrence. All the patients presented with acute coronary syndrome (ACS) during the initial and recurrent episode. At the initial presentation, all the patients underwent selective coronary angiography (CA), transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR) evaluation. However, the recurrent episodes were diagnosed without the need of CA, except in 1 patient who presented with ST-segment elevation myocardial infarction.
  
  
  CONCLUSIONS
  Recurrence of TTC is common and can be diagnosed without CA in some cases. During recurrence, the regional involvement of the left ventricle can vary in the same person. Variable regional involvement in the same patient rules out some of the proposed theories on the pathogenesis such as: beta-receptor gradient, wrap-around left anterior descending, and coronary artery spasm.
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, 28 Woodville Road, 5011, Woodville South, SA, Australia, kjaulakh@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Parsaik
authors.forename: B
authors.initials: B
authors.lastname: Singh
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*