Case report


Lakshmi Kant Pathak.^1,*, MD, MRCP, FACP, Chirag Chavda².,MD, Mohamed Mohamed,^1,±, MD, Vimala Vijayaraghavan³, MD


Affiliation:
^1,*,±Sanford Medical Center, University of North Dakota, Fargo, USA
²Methodist Health system, Dallas, USA
³Caribbean Medical University, Chicago, USA

The name of the department(s) and institution(s) to which the work should be attributed:
1.Sanford Medical Center, University Of North Dakota, Fargo, USA
2.Methodist Health system, Dallas, USA
3.Caribbean Medical University, Chicago, USA

Address reprint requests to
Dr Lakshmi Kant Pathak, MD, MRCP, FACP
Sanford Medical Center, University of North Dakota, Fargo, USA

Article citation:
Pathak LK,Chavda C,Mohamed M,Vijayaraghavan V.  The idiom, laughter is the best medicine is not always true. Takotsubo Cardiomyopathy precipitated by positive emotion, recurrence in the patient. Understanding the facts and review of literature. J Pharm Biomed Sci. 2015; 05(02):131-133. Available at www.jpbms.info

ABSTRACT:
Takotsubo Cardiomyopathy is a rare but well described entity. The disease is also known as stress induced cardiomyopathy or apical ballooning syndrome. As the name implies, it is usually but not always associated with an antecedent stressful event. Almost all cases of Takotsubo cardiomyopathy are triggered by negative stressors such as anger, grief, and anxiety. Some cases are triggered by physical exertion. Complete recovery is the most common outcome and recurrence is very rare. It is also called broken heart syndrome.
It mimics acute coronary syndrome and the correct diagnosis is based on angiographic finding of apical ballooning in the absence of significant coronary obstruction.
This article reports a unique case of recurrence of Takotsubo cardiomyopathy not described before triggered by a positive emotion in the same patient. To our knowledge, this is the only case report of recurrence twice following positive emotion as the trigger in the same patient. This patient condition on the contrary can be called   "happy heart syndrome" or may be “laughter disaster”.
The patient had an uneventful course following both episodes.
The article also reviews briefly the literature available on etiology, pathogenesis andprognosis..

KEYWORDS: Takotsubo cardiomyopathy; recurrence; positive emotions; LV dysfunction.

Statement of Originality of work: The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and that each author believes that the manuscript represents honest and original work.


REFERENCES
1."Happiness" and stress cardiomyopathy (apical ballooning syndrome/Takotsubo syndrome) Int J Cardiol. 2014;172(1):e182-3. doi: 10.1016/j.ijcard.2013.12.140. Epub 2014 Jan 4.
2.Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Pilgrim TM, Wyss TR. Int J Cardiol. Mar 14 2008; 124(3):283-92.
3.Singh K, Carson K, Usmani Z, et al. Systematic review and meta-analysis of incidence and correlates of recurrence of Takotsubo cardiomyopathy. Int J Cardiol. Jul 1 2014; 174(3):696-701.
4.Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of Takotsubo cardiomyopathy. Circ J. Jun 2007; 71(6):990-2.


Source of funding: None

Competing interest / Conflict of interest: The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.


Disclaimer: Any views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of Defense.


Copyright © 2015 Pathak LK, Chavda C, Mohamed M, Vijayaraghavan V. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.