An Unusual Case of Takotsubo Syndrome with Extreme QTc Prolongation: A Case Report

Abstract

Abstract Introduction Takotsubo syndrome is a transient stress-induced cardiomyopathy characterized by reversible left ventricular dysfunction and dynamic electrocardiographic abnormalities. QTc prolongation is common and may increase the risk of malignant ventricular arrhythmias. We report an unusual case of extreme QTc prolongation without major arrhythmic complications. Case Presentation A 54-year-old woman with hypertension and a previous episode of Takotsubo syndrome presented with acute chest pain following emotional stress. Admission electrocardiography showed sinus rhythm with right bundle branch block and a QTc of 395 ms. Echocardiography revealed apical ballooning with a left ventricular ejection fraction of 35%, while coronary angiography excluded obstructive coronary artery disease. On day 2, the QTc markedly prolonged to 768 ms despite normal electrolyte levels and the absence of QT-prolonging medications. Serial electrocardiograms demonstrated progressive QTc shortening in parallel with recovery of ventricular function. Holter monitoring revealed only rare ventricular ectopy and brief ventricular bigeminy without sustained arrhythmias. At discharge, the QTc had decreased to 450 ms, and no major arrhythmic events were detected during one-month follow-up. Conclusions Extreme QTc prolongation may occur in Takotsubo syndrome without malignant ventricular arrhythmias. This case suggests that QTc duration alone may not accurately reflect arrhythmic risk and highlights the importance of careful rhythm monitoring during the acute phase of the syndrome.