Inverted variant of Takotsubo Syndrome caused by inhaled adrenergic beta-2 agonists

Abstract

Takotsubo syndrome (TS) is an acute and reversible clinical syndrome characterized by transient hypokinesis of the left ventricular (LV) apex. Variant forms of LV dysfunction have been reported, including inverted Takotsubo syndrome (ITS), which represents only 5% of cases and has previously been linked to excessive use of inhaled adrenergic beta-2 agonists. The authors describe the case of a 60-year-old female patient who was diagnosed with ITS after the excessive use of inhaled adrenergic beta-2 agonists. This case highlights an uncommon variant of this syndrome that may not be obvious and must be suspected in this particular context. LEARNING POINTS • Takotsubo syndrome (TS) was initially described with a classic pattern of LV apical akinesis and accounts for around 75–80% of cases. Variants including inverted Takotsubo (also known as basal variant) can affect other areas of the myocardium. • Several physiopathological mechanisms have been implicated. Catecholamine-induced cardiotoxicity is one of the most supported theories, while other triggers, including excessive use of inhaled beta-2 agonists, have also been described. • Treatment of TS is mainly symptomatic and conservative and frequently leads to rapid resolution and LV function recovery.