Takotsubo Cardiomyopathy in the Third Trimester of Pregnancy: A Case Report

Takotsubo cardiomyopathy is a rare and transient form of left ventricular dysfunction, often triggered by acute emotional or physical stress. We report the case of a 32-year-old woman, eight months pregnant, who developed progressive dyspnea and lower limb edema initially attributed to pregnancy-related symptoms. The recent loss of her mother represented a major emotional trigger. Worsening of symptoms prompted her admission to the emergency department. Diagnostic investigations, including laboratory testing, transthoracic echocardiography, and cardiac MRI, established the diagnosis of Takotsubo cardiomyopathy, with early-onset peripartum cardiomyopathy considered as the main differential diagnosis. Management was restricted by pregnancy and consisted of symptomatic therapy with beta-blockers and diuretics. An elective cesarean delivery was performed successfully. Postpartum, standard guideline-directed medical therapy for heart failure was initiated, leading to complete recovery of cardiac function. This case highlights the diagnostic challenges of Takotsubo cardiomyopathy during pregnancy, where it can mimic physiological changes of gestation or peripartum cardiomyopathy.