Takotsubo cardiomyopathy (TCM) is a type of disorder of cardiomyocytes in which there is apical akinesia and ballooning, whereas the base is hyperkinetic. Reverse Takotsubo cardiomyopathy (rTCM) is a rare variant of TCM in which the base of the heart is akinetic and ballooned out rather than the apex, which is hyperkinetic. Takotsubo cardiomyopathy is usually seen in postmenopausal women, but a rising number of cases of the reverse variant are being reported in peripartum women. We present a case of a 24-year-old primigravida at 37 weeks of gestation, who presented with an acute onset of breathlessness just after cesarean delivery. A 2D echocardiogram revealed changes of rTCM with an overall ejection fraction of 40%. She was treated for the same, and a 2D echocardiogram repeated after 1 week showed improvement in the ejection fraction to >60%, which supported our diagnosis of peripartum rTCM. Another important objective of this study is to differentiate TCM occurring in the peripartum period from peripartum cardiomyopathy (PPCM), both of which are clinically indistinguishable but have different etiopathogenesis, treatment, and prognosis. While rTCM treatment mostly includes the management of heart failure, such as oxygen supplementation, diuretics, and noninvasive mechanical ventilation, the management of PPCM also includes bromocriptine, along with treating heart failure. The outcome of rTCM is excellent, with recovery of left ventricle function in almost all cases, while a few patients of PPCM have irreversible heart failure, making it imperative to differentiate between the two clinical entities.
Ojha et al. (2026) studied this question.