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Rarely, it can be complicated by conduction abnormalities, including high-grade atrioventricular (AV) block. We report a 79-year-old woman with poorly controlled hypertension and preexisting trifascicular block who developed chest pain triggered by extreme emotional stress and presented with lateral ST elevation myocardial infarction on ECG. Coronary angiography showed unobstructed coronaries with classic apical ballooning. Echocardiography and cardiac MRI within 48 hours confirmed TTC. Progression to Mobitz II and high-grade AV block occurred over days, and due to persistent LV dysfunction and high pacing dependency, the multidisciplinary team selected CRT-P, implanted successfully. This case underscores early recognition and individualized pacing strategies in patients with underlying conduction disease.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/takotsubo-cardiomyopathy-complicated-by-high-grade-atrioventricular-block-in-a-patient-with-preexisting-conduction-disease-a-case-report/460895/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/takotsubo-cardiomyopathy-complicated-by-high-grade-atrioventricular-block-in-a-patient-with-preexisting-conduction-disease-a-case-report/460895.png","ImageObject",300,407,{"name":92,"@type":93},"Aria Callaghan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why did the patient initially appear to have an acute coronary syndrome?","Question",{"text":112,"@type":113},"She presented with chest pain and ECG findings suggestive of lateral myocardial infarction, along with elevated troponin-T. TTC can mimic acute coronary syndrome with similar clinical and ECG features.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was Takotsubo cardiomyopathy confirmed in this case?",{"text":117,"@type":113},"Emergency invasive coronary angiography showed unobstructed coronaries, while ventriculography demonstrated classic apical ballooning of the left ventricle. Transthoracic echocardiography and cardiac MRI within 48 hours confirmed TTC.",{"name":119,"@type":110,"acceptedAnswer":120},"What complication developed over the following days, and how was it managed?",{"text":121,"@type":113},"She progressed from Mobitz II AV block to high-grade AV block. Because of persistent poor left ventricular systolic function and high risk of pacing dependency, the multidisciplinary team chose a CRT-P pacemaker, which was implanted successfully.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},460895,1790814314,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review began 11/12/2025  \nReview ended 12/04/2025  \nPublished 12/10/2025  \n© Copyright 2025  \nPitto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98876  \nOpen Access Case Report  \nTakotsubo Cardiomyopathy Complicated by HighGrade Atrioventricular Block in a Patient With Preexisting Conduction Disease: A Case Report  \nNicholas G. Pitto 1, Kirollos Philops 1 , Kokhoon Tay 1 , Louise A. Brown 1, 2, 3  \n1. Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, GBR 2. Cardiology, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, GBR 3. Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, GBR  \nCorresponding author: Nicholas G. Pitto, [nicholas.pitto@nhs.net](nicholas.pitto@nhs.net)  \nAbstract  \nTakotsubo cardiomyopathy (TTC) often mimics acute coronary syndrome, presenting with chest pain, electrocardiogram (ECG) changes, and troponin rise. While usually reversible, it can rarely be complicated by conduction abnormalities such as high-grade atrioventricular (AV) block.  \nWe report a 79-year-old woman with poorly controlled hypertension and preexisting trifascicular block who presented with chest pain precipitated by extreme emotional stress due to the inability to obtain her antihypertensive tablets prescription via her General Practitioner, coinciding with the anniversary of her husband’s death. Initial evaluation based on her 12-lead ECG was in keeping with a lateral ST elevation myocardial infarction, but emergency invasive coronary angiography revealed unobstructed coronaries with classical apical ballooning of the left ventricle. Transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (MRI) within 48 hours confirmed TTC. Over the following days, she developed Mobitz II AV block progressing to high-grade AV block. Given her persistent poor left ventricular systolic function and high risk of pacing dependency, the consensus opinion after discussion in the multidisciplinary device team meeting opted for a cardiac resynchronisation therapy pacemaker (CRT-P), which was implanted successfully.  \nThis case highlights the rare association between TTC and high-grade AV block, particularly in patients with underlying conduction disease. Early recognition and individualised pacing strategies are essential for improving outcomes.  \nCategories: Cardiology, Emergency Medicine, Internal Medicine  \nKeywords: cardiac resynchronization therapy (crt), high degree av block, permanent pacemaker implantation (ppm), takotsubo cardioyopathy, trifascicular block  \nIntroduction  \nTakotsubo syndrome (TTC), first described in the 1990s in Japan [1], can often present similarly to an acute coronary syndrome, with chest pain, raised cardiac enzymes and ECG changes. It is named after the characteristic left ventricular changes, in the absence of coronary artery disease, which resemble Japanese octopus traps. It disproportionately affects older women; about 90% of 1750 cases in the International Takotsubo Registry were women with a mean age of 67 [1] . Whilst previously thought of as being triggered by emotional stressors, both positive and negative, physical stressors such as physical activities and medical conditions or procedures are more common triggers and nearly one third occur in the absence of any known trigger [1-2]. Although the pathophysiology of TTC remains poorly understood, it is thought to be associated with sympathetic stimulation and catecholamine excess [1] .  \nThere are cases of high-grade AV block as a complication of TTC in the literature [3-5] as well as reports of CHB [6-8]. A review of arrhythmia occurrence with TCC lo","cbCaisJoRpJItA13","https://ap.wps.com/l/cbCaisJoRpJItA13","pdf",5915595,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"Why did the patient initially appear to have an acute coronary syndrome?\",\"answer\":\"She presented with chest pain and ECG findings suggestive of lateral myocardial infarction, along with elevated troponin-T. TTC can mimic acute coronary syndrome with similar clinical and ECG features.\"},{\"question\":\"How was Takotsubo cardiomyopathy confirmed in this case?\",\"answer\":\"Emergency invasive coronary angiography showed unobstructed coronaries, while ventriculography demonstrated classic apical ballooning of the left ventricle. Transthoracic echocardiography and cardiac MRI within 48 hours confirmed TTC.\"},{\"question\":\"What complication developed over the following days, and how was it managed?\",\"answer\":\"She progressed from Mobitz II AV block to high-grade AV block. Because of persistent poor left ventricular systolic function and high risk of pacing dependency, the multidisciplinary team chose a CRT-P pacemaker, which was implanted successfully.\"}]","Takotsubo Cardiomyopathy Complicated by High-Grade Atrioventricular Block in a Patient With Preexisting Conduction Disease - A Case Report | PDF",1790760014,18]