¹Resident in Internal Medicine Training, Department of Internal Medicine, Unidade Local de Saúde do Oeste – Hospital Caldas da Rainha, Caldas da Rainha, Portugal; ORCID: https://orcid.org/0000-0001-9503-7049.

²Resident in Internal Medicine Training, Department of Internal Medicine, Unidade local de Saúde do Alto Alentejo – Hospital de Portalegre, Portalegre, Portugal, ORCID: https://orcid.org/0000-0002-1994-7849.

³Senior Consultant in Internal Medicine, Casa Santa Maria (RNCCI/ERPI), Lisboa, Portugal; ORCID: https://orcid.org/0000-0003-4448-4169.

Corresponding Author: Sara Lourenço Tereso, ORCID: https://0000- 0001-9503-7049, Rua Diário de Notícias, 2500-176, Caldas da Rainha, Portugal.

Citation: Sara Tereso, Elisabete Mendes, Carlos Machado e Costa (2026). Takotsubo Syndrome with Transient Apical Ballooning. Euro J Case Rep Clin Imag. 2026; August, e22,1-3.

Copyrights: © Sara Lourenço Tereso, 2026, et al., This article is licensed under the Creative Commons Attribution-Non Commercial-4.0-International-License-(CCBY-NC) (https://europeanjournalofcasereports.com/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

Image Case Presentation:

A 73-year-old woman with arterial hypertension presented to the hospital with chest pain radiating to the shoulders and back, beginning the previous day, lasting 12 hours, and recurring with minimal exertion. The pain was associated with an episode of anxiety related to her son’s recent job loss. On physical examination, vital signs were stable. Laboratory tests showed a troponin T of 231 ng/L. The electrocardiogram demonstrated sinus rhythm at 84 bpm, with mild ST segment elevation in V2–V4, biphasic P waves, and T wave inversion from V2 to V6. Transthoracic echocardiography revealed apical hypokinesia. Coronary angiography excluded significant coronary lesions. Left ventriculography showed contractility abnormalities of the left ventricle, with akinesia of the apex and apical segments, and a left ventricular ejection fraction of 48%, findings suggestive of Takotsubo syndrome (TS). The diagnosis was established based on the clinical presentation and imaging features (Figures 1A, 1B). Supportive treatment was initiated, and repeat echocardiography demonstrated recovery of segmental wall motion in the apical segments, with preserved global systolic function (LVEF 63%). TS is characterised by transient left ventricular dysfunction with abnormal wall motion [1] and apical ballooning [2]. It predominantly affects postmenopausal women and is usually triggered by emotional or physical stress, [1-4] mimicking an acute coronary syndrome, [2,3] which makes diagnosis challenging [1]. Coronary angiography with left ventriculography remains the gold standard, and the condition generally carries a favorable prognosis [1].

Declarations:

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Informed consent for publication was obtained from the patient’s legal guardians.

Data Availability Statement: No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Acknowledgments: Not applicable.

Conflicts of Interest: We confirm that there are no conflicts of interest to declare.

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2. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006 July, 27:1523-9. DOI: 10.1093/eurheartj/ehl032.

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