Sinus Node Dysfunction in Takotsubo Syndrome: An Uncommon Presentation.

BACKGROUND

Stress cardiomyopathy is an acute, usually reversible left ventricular (LV) systolic dysfunction often triggered by emotional or physical stress. Conduction system complications are uncommon.

CASE SUMMARY: A 68-year-old patient presented with acute pulmonary edema, reduced LV ejection fraction, and troponin elevation. Coronary angiography excluded obstructive coronary artery disease, and cardiac magnetic resonance confirmed stress cardiomyopathy. During hospitalization, the patient developed sinus node dysfunction (SND). Despite complete recovery of LV systolic function, the conduction abnormality persisted, requiring permanent pacemaker implantation.

DISCUSSION: Arrhythmias occur in up to one-quarter of patients with stress cardiomyopathy, most commonly atrial fibrillation or ventricular arrhythmias, whereas persistent SND is rare. This case highlights that recovery of ventricular systolic function does not necessarily indicate recovery of conduction abnormalities and underscores the need for careful rhythm monitoring and individualized pacing decisions.

TAKE-HOME MESSAGE: Persistent SND may complicate stress cardiomyopathy and may require permanent pacemaker implantation.