A fatal combination in an old lady: Tako-Tsubo cardiomyopathy, long QT syndrome, and cardiac hypertrophy

Tako-Tsubo cardiomyopathy (TT-CM), also called stress-induced cardiomyopathy or transient left ventricular (LV) apical ballooning syndrome, is characterized by transient apical or midventricular LV dysfunction that mimics myocardial infarction, but in the absence of significant coronary artery disease. The onset of TT-CM is typically triggered by an acute medical illness or by intense emotional, psychological, or physical stress. During the acute phase, a disturbed repolarization with QT prolongation in the surface ECG is frequently obvious. Despite the generally good prognosis of TT-CM, severe clinical courses have been reported due to the depressed LV function with cardiogenic shock or malignant tachyarrhythmias. We report an unusual presentation of a patient with TT-CM and recurrent episodes of torsades de pointes tachyarrhythmias. In this patient, we identified pre- and coexisting congenital long QT syndrome and severe cardiac hypertrophy--all of them associated with disturbed myocardial repolarization and predisposed the patient to malignant tachyarrhythmias.