Myocardial stunning identified by using strain/strain rate imaging during dobutamine stress echocardiography in a rare late recurrence of Tako–Tsubo syndrome

Tako–Tsubo cardiomyopathy affects postmenopausal women and is often associated to emotional or physical stress. It is typically characterized by transient left ventricular apical ballooning with chest pain and, electrocardiographic changes and biochemical markers suggestive of acute coronary syndrome, despite angiographically normal coronary arteriograms. The pathogenesis of the condition is still unknown, but increased catecholamine levels have been postulated as a pathogenic mechanism. Little data exist in the medical literature regarding recurrent events in this disorder. We present here a case of a 62 year-old woman who had a recurrent episode of Tako–Tsubo syndrome 6 years after initial presentation with typical features of the condition. An underlying cause could not be found that could explain the recurrence of this late episode.