Atypical Pediatric Presentation of Takotsubo Syndrome.

BACKGROUND

Takotsubo syndrome (TS) is a transient, nonischemic cardiomyopathy in children, typically associated with severe physiologic stressors.

CASE SUMMARY: A 17-year-old boy presented with acute chest pain following emotional distress and exertion. Evaluation revealed ST-segment elevations, markedly elevated troponin levels, left ventricular apical wall motion abnormalities on echocardiography, and normal coronary angiography. Cardiac magnetic resonance imaging confirmed apical hypokinesis with myocardial edema and late gadolinium enhancement. He was also found to have severe hyperglycemia consistent with new-onset type 2 diabetes mellitus.

DISCUSSION: This case highlights an atypical presentation of pediatric TS triggered by emotional stress and raises the possibility of metabolic dysregulation as a contributor.

TAKE-HOME MESSAGES: TS, although rare in adolescents, can occur without a classic physiologic stressor, and untreated type 2 diabetes may represent a contributing factor. Cardiac magnetic resonance imaging plays a critical role in differentiating TS from alternative diagnoses and documenting myocardial recovery.