Midventricular Takotsubo Cardiomyopathy Masquerading as Inferior Wall ST-elevation Myocardial Infarction

Abstract Takotsubo cardiomyopathy (TTC) is characterized by transient systolic dysfunction of the left ventricle in the absence of obstructive coronary artery disease, typically triggered by emotional or physical stress. A 73-year-old male presented with a scrotal abscess complicated by septic shock. On day 2 of hospitalization, he developed acute chest pain. Electrocardiography (ECG) showed ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in leads aVL and V1–V4, suggestive of inferior wall ST-elevation myocardial infarction (STEMI). High-sensitivity troponin T was elevated (50 ng/L), which was modest relative to the extent of ECG changes. Transthoracic echocardiography revealed left ventricular systolic dysfunction (left ventricular ejection fraction 40% by Simpson’s biplane method) with hypokinesia of the mid-left ventricular segments and preserved basal and apical contractility. Emergency coronary angiography demonstrated angiographically normal epicardial coronary arteries with no evidence of obstructive disease, thrombus, or dissection. Left ventricular angiography revealed circumferential hypokinesia of the mid-ventricular segments with hypercontractile basal and apical segments, consistent with midventricular TTC. The patient was managed conservatively with antibiotics and supportive care, resulting in the complete resolution of ECG changes and normalization of left ventricular function. Midventricular TTC is a rare variant that can closely mimic inferior-wall STEMI. Recognition of this entity is essential to avoid inappropriate reperfusion therapy.