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Background:

Takotsubo cardiomyopathy (TCM) commonly manifests as dilation of the apical left ventricular (LV) segments. Apical hypertrophic cardiomyopathy (AHCM) is a genetic disorder defined by apical LV hypertrophy in the absence of abnormal loading conditions. We report a rare case of myocardial edema due to TCM presenting as AHCM.

Case:

A 63-year-old man with alcoholic cirrhosis developed worsening LV function 2 days after liver transplantation (LT). Troponin I [peak: 1.10 ng/mL (normal< 0.08 ng/mL)] was elevated and echocardiography (TTE) showed severely reduced LV function, severe hypokinesis in mid and apical segments with hyperdynamic contractility at the base with no cardiac symptoms, suggesting a diagnosis of TCM. Repeat TTE a week later showed improvement in ejection fraction to 45% with a new apical wall thickening (AWT) mimicking AHCM which was not present before.