A rare case of left ventricular cardiac rupture in the acute phase of takotsubo syndrome.

UNLABELLED: Takotsubo syndrome (TTS), often triggered by emotional or physical stress, is characterized by transient left ventricular dysfunction that mimics acute coronary syndrome. We present a case involving an 85-year-old woman with a history of atrial fibrillation who developed sudden severe chest pain during sleep. Initial evaluation suggested ST elevation myocardial infarction; however, emergency coronary angiography revealed patent coronary arteries, leading to a diagnosis of TTS. Immediately after angiography, the patient experienced sudden loss of consciousness, which resulted in death with diminished circulating plasma volume. Autopsy confirmed mid-antero-septal wall rupture with massive left pleural thrombus, suggesting cardiac rupture due to TTS as the cause of death. Our case represents a rare case of TTS complicated by cardiac rupture in the ultra-acute phase, highlighting the critical importance of early recognition and urgent intervention in high-risk patients.

LEARNING OBJECTIVE: Takotsubo syndrome (TTS) usually has a favorable prognosis but can cause severe complications such as cardiogenic shock, left ventricular outflow obstruction, and, rarely, cardiac rupture (CR). Although uncommon, CR is life-threatening and requires vigilance in high-risk patients. This case highlights the critical importance of early recognition and urgent intervention in high-risk patients with TTS to prevent catastrophic outcomes.