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This case describes a 38-year-old woman with depression who developed acute psychosis and required haloperidol sedation. Inferolateral ST elevation was noted despite minimal symptoms, while troponin I (>24,000 ng/L) and creatine kinase were disproportionately high. Echocardiography showed severe apical akinesia (EF ~35%) and coronary CT confirmed unobstructed arteries with zero calcium score. Conservative cardiac management plus multidisciplinary psychiatric guidance supported recovery, with improved EF on follow-up.",{"@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-with-markedly-elevated-troponin-triggered-by-acute-psychosis-a-case-report/455333/",{"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-with-markedly-elevated-troponin-triggered-by-acute-psychosis-a-case-report/455333.png","ImageObject",300,407,{"name":92,"@type":93},"LangkahRina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was acute coronary syndrome initially a concern in this case?","Question",{"text":112,"@type":113},"Troponin I and creatine kinase were markedly elevated and the ECG showed inferolateral ST-segment elevation, which can resemble ACS. The degree of troponin rise was unusually high for typical Takotsubo cardiomyopathy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What investigations confirmed Takotsubo cardiomyopathy instead of obstructive coronary disease?",{"text":117,"@type":113},"Bedside echocardiography demonstrated severe left ventricular systolic dysfunction with apical akinesia and aneurysmal morphology. Coronary CT angiography showed unobstructed coronary arteries and a zero calcium score, supporting Takotsubo cardiomyopathy.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the patient managed during admission?",{"text":121,"@type":113},"She was treated conservatively in the coronary care unit with bisoprolol and dapagliflozin, while psychiatry guided safe antipsychotic use due to QT-prolongation risk. Follow-up echocardiography showed improvement in left ventricular function and resolution of symptoms.","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},455333,1790794677,{"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":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"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},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/25/2025  \nReview ended 12/04/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nKalra 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.98683  \nOpen Access Case Report  \nTakotsubo Cardiomyopathy With Markedly  \nElevated Troponin Triggered by Acute Psychosis: A Case Report  \nTarunjog Singh Kalra 1, Muhammad Shahid 2 , Waseem Khamboo 2, Zoha Naeem 1, Hania Afsar 1  \n1. Internal Medicine, Russells Hall Hospital, Dudley, GBR 2. Cardiology, Russells Hall Hospital, Dudley, GBR Corresponding author: Tarunjog Singh Kalra, [tarunjog.kalra@nhs.net](tarunjog.kalra@nhs.net)  \nAbstract  \nTakotsubo cardiomyopathy (TTC) is an acute, reversible form of left ventricular dysfunction that mimics acute coronary syndrome (ACS), typically presenting with modest troponin elevation. We report a 38-yearold woman with a history of depression, who presented with acute psychosis requiring haloperidol sedation. Routine ECG monitoring revealed inferolateral ST-segment elevation, although she was asymptomatic at presentation and recalled only a non-specific burning chest discomfort three days prior. Laboratory tests demonstrated markedly elevated troponin I (>24,000 ng/L) and creatine kinase (5,931 U/L), unusual for TTC and suggestive of ACS. Bedside echocardiography revealed severe left ventricular systolic dysfunction with apical akinesia (ejection fraction (EF) ~35%), while coronary CT angiography showed unobstructed coronary arteries and a zero calcium score, confirming TTC. She was managed conservatively in the coronary care unit with bisoprolol and dapagliflozin, and psychiatric input guided safe antipsychotic use. Follow-up echocardiography demonstrated improvement in left ventricular function (EF 45%-49%), with resolution of symptoms.  \nThis case highlights the rare occurrence of TTC with disproportionately high troponin levels and underscores the importance of multimodal imaging and multidisciplinary management in patients with psychiatric comorbidities to avoid misdiagnosis and unnecessary invasive procedures.  \nCategories: Cardiology, Emergency Medicine, Internal Medicine  \nKeywords: apical ballooning syndrome, broken-heart syndrome, psychosis, stress induced cardiomyopathy, takotsubo cardiomyopathy (ttc)  \nIntroduction  \nTakotsubo cardiomyopathy (TTC), also referred to as stress-induced cardiomyopathy, is characterized by transient systolic dysfunction of the left ventricle, most commonly involving apical ballooning. It is typically precipitated by intense emotional or physical stressors and presents clinically in a manner similar to acute coronary syndrome (ACS), with chest pain, ECG changes, and elevated cardiac biomarkers [1,2] .  \nTroponin elevation in TTC is usually modest relative to the degree of left ventricular wall motion abnormality, and disproportionately high levels are uncommon [1,2] . Psychiatric illness, including acute psychosis, is a recognized precipitating factor, due to catecholamine surges and heightened sympathetic activation [1,3] .  \nUnderstanding TTC is clinically important because it mimics ACS but usually does not involve obstructive coronary disease, and misdiagnosis may lead to unnecessary interventions. The pathophysiology involves catecholamine-mediated myocardial stunning, highlighting the link between acute stress, sympathetic activation, and transient cardiac dysfunction. We present a rare case of TTC associated with extremely elevated troponin levels, complicating differentiation from ACS.  \nCase Presentation  \nA 38-year-old woman with a background of depression, maintained on sertraline 100 mg once daily, was admitted following an acute psychotic episode. On arrival, she exhibited severe agitation and aggression, requiring pharmacological sedation. She was administered ","cbCaijIvullXvaRw","https://ap.wps.com/l/cbCaijIvullXvaRw","pdf",3480310,"English","# Abstract\n# Introduction\n# Case Presentation\n# How to cite this article\n# FIGURE 1 : ECG shows inferolateral ST-segment elevation","[{\"question\":\"Why was acute coronary syndrome initially a concern in this case?\",\"answer\":\"Troponin I and creatine kinase were markedly elevated and the ECG showed inferolateral ST-segment elevation, which can resemble ACS. The degree of troponin rise was unusually high for typical Takotsubo cardiomyopathy.\"},{\"question\":\"What investigations confirmed Takotsubo cardiomyopathy instead of obstructive coronary disease?\",\"answer\":\"Bedside echocardiography demonstrated severe left ventricular systolic dysfunction with apical akinesia and aneurysmal morphology. Coronary CT angiography showed unobstructed coronary arteries and a zero calcium score, supporting Takotsubo cardiomyopathy.\"},{\"question\":\"How was the patient managed during admission?\",\"answer\":\"She was treated conservatively in the coronary care unit with bisoprolol and dapagliflozin, while psychiatry guided safe antipsychotic use due to QT-prolongation risk. Follow-up echocardiography showed improvement in left ventricular function and resolution of symptoms.\"}]","Takotsubo Cardiomyopathy With Markedly Elevated Troponin Triggered by Acute Psychosis - A Case Report | PDF",1790742638,23]