Recurrent Seizure-Triggered Takotsubo Syndrome With Phenotypic Switching and Rapid Functional Recovery: A Case Report

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Takotsubo syndrome (TTS) is an acute cardiomyopathy characterized by transient left ventricular systolic dysfunction, often mimicking acute coronary syndrome. Current pathophysiological concepts emphasize sympathetic overactivity and catecholamine excess as major determinants of myocardial stunning, and experimental models further suggest that high epinephrine concentrations may induce a beta-2 adrenoceptor Gs-to-Gi signaling switch, contributing to severe but reversible myocardial dysfunction. Neurological triggers, particularly epileptic seizures, are increasingly recognized and may be associated with distinctive clinical profiles, arrhythmic complications, recurrence, and variable ventricular morphology. We report the case of a 57-year-old woman with epilepsy and chronic obstructive pulmonary disease who presented with acute chest pain immediately after a generalized tonic-clonic seizure. She had experienced a previous TTS episode 11 months earlier, documented as a mid-ventricular variant with a left ventricular ejection fraction (LVEF) of 50%. During the recurrent episode, electrocardiography showed sinus rhythm without ST-segment elevation, with known anteroseptal T-wave inversion. Serial laboratory testing demonstrated a relatively modest peak high-sensitivity troponin T level of 140 pg/mL despite severe left ventricular dysfunction, together with markedly elevated N-terminal pro-B-type natriuretic peptide. Transthoracic echocardiography showed an LVEF of 20%-25%, with apical hypokinesia extending to the adjacent mid-ventricular segments and relative basal hypercontractility. Coronary angiography showed no acute culprit lesion and was unchanged from the prior examination. Left ventriculography confirmed apical ballooning with mid-ventricular extension. By day 3, LVEF had improved to 52%, while cardiac magnetic resonance imaging showed normalized wall motion with mild residual myocardial edema. This case highlights recurrent seizure-triggered TTS with documented phenotypic switching and rapid functional recovery, emphasizing the value of multimodality imaging and coordinated neuro-cardiac management.

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