{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:07:01Z","timestamp":1756339621106,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,8,16]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>A woman in her 60s presented initially with nausea, vomiting and abdominal pain. She rapidly progressed to respiratory failure requiring intubation. ECG demonstrated no significant ST segment changes. Troponin I and brain natriuretic peptide were elevated. Chest CT angiography demonstrated small non-occlusive segmental pulmonary emboli. Transthoracic echocardiogram findings suggested biventricular takotsubo cardiomyopathy (TCM) with left ventricular ejection fraction of less than 20%. She improved with aggressive management and was discharged on carvedilol, lisinopril, atorvastatin and apixaban. Follow-up echocardiogram revealed complete resolution of the left and right ventricular wall motion abnormalities at 9 weeks. She had symptoms recurrence after 7 months from the initial presentation. Repeated echocardiogram was consistent with biventricular TCM recurrence. Despite aggressive medical therapy, multiorgan failure developed and patient care was later transitioned to palliative care.<\/jats:p>","DOI":"10.1136\/bcr-2022-249910","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T12:41:05Z","timestamp":1663591265000},"page":"e249910","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Recurrent biventricular takotsubo cardiomyopathy with fatal outcome"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-6913","authenticated-orcid":false,"given":"Abdul-Fatawu","family":"Osman","sequence":"first","affiliation":[{"name":"Internal Medicine, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-2473","authenticated-orcid":false,"given":"Si Yuan","family":"Khor","sequence":"additional","affiliation":[{"name":"Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2919-6196","authenticated-orcid":false,"given":"Basel","family":"Abdelazeem","sequence":"additional","affiliation":[{"name":"Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waseem","family":"Barham","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"2025082712261440000_15.9.e249910.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406761"},{"key":"2025082712261440000_15.9.e249910.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.02.029"},{"key":"2025082712261440000_15.9.e249910.3","doi-asserted-by":"publisher","DOI":"10.1177\/2048872615612456"},{"key":"2025082712261440000_15.9.e249910.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"2025082712261440000_15.9.e249910.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs215"},{"key":"2025082712261440000_15.9.e249910.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.017"},{"key":"2025082712261440000_15.9.e249910.7","unstructured":"O\u2019Gara PT , Kushner FG , et al . 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of cardiology Foundation\/American heart association Task force on practice guidelines. 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