A Rare Double Trigger for Takotsubo Cardiomyopathy

A woman admitted to the hospital for a massive Pulmonary Embolism, developed, at stable emodinamic condition, a complex clinical scenario characterized by Crohn disease exacerbation, chest pain and worsening dyspnea. The electrocardiogram presented non-specific repolarization changes. Echocardiogram showed new Left Ventricle akinesis of the apex and medium-apical segments, hyperkinetic basal segment with reduced ejection fraction. Coronarography showed not significant coronary artery disease and typical left ventricle apical ballooning. Left ventricle dysfunction recovered spontaneously in few days. This is the first case of Takotsubo Cardiomyopathy in course of pulmonary embolism and Crohn disease exacerbation. Summary: Takotsubo Cardiomyopathy is a syndrome characterized by acute regional systolic dysfunction of the left ventricle, frequently related to psycho-physical acute stress and usually reversible, in the absence of significant coronary artery disease. No cases have been reported of Takotsubo Cardiomyopathy associated with pulmonary embolism in the context of Crohn disease reacutization.