“Nutritional or Hormonal”, The Myth of Takotsubo Cardiomyopathy and Left Ventricular Thrombosis in Anorexia Nervosa Patients! A Case Report

Takotsubo Cardiomyopathy is a condition characterized by transient LV hypokinesis without evidence of obstructive coronary disease that is typically triggered by a stressful event. We describe a 34-year-old woman with anorexia nervosa presenting with hypotension, hypoglycemia, and tachycardia and found to have Takotsubo Cardiomyopathy. On admission, EKG showed ST depression with T wave inversion in the inferolateral leads and Q waves in the anteroseptal leads (V1-V3). The initial troponin was elevated at 1.2 ng/ml and increased to 1.94 ng/ml 4 hours later. Initial TTE showed global hypokinesisexcept for a hyperkinetic basal segment suggestive of takostsubo cardiomyopathy and an EF of 15-20%. During the course of management, subsequent TTEs revealed improved EF with resolution of the cardiomyopathy, but also the presence of an LV thrombus. The pathophysiology of Takotsubo Cardiomyopathy is not fully understood, and the impact of the hypoestrogenic state and the nutritional deficiencies on the development Takotsubo Cardiomyopathy in anorexia nervosa patients remains to be a myth.