Takotsubo cardiomyopathy caused by hypoglycemia: A unique association with coronary arterial calcification

Several factors attributable to the onset of Takotsubo type of cardiomyopathy are known. We report a case of a postmenopausal female, who represented with syncope and was found to be hypoglycemic and had elevated cardiac biomakers. Later found to have Takotsubo type of cardiomyopathy after a negative coronary angiogram. The left ventricular function improved over a week. She had unusual combination of hypoglycemia and cortisol excess; this is not reported in the literature. The urine catecholamines were normal. We also report a unique occurrence of coronary artery calcification as one of the associations with Takotsubo syndrome. This feature may help in risk assessment and reccurence of this syndrome. Further studies are needed to confirm this association and its prognostic significance.