A Rare Case of Stress Cardiomyopathy Following Traumatic Fall: Diagnostic Clues and Recovery

Abstract

Introduction
Stress cardiomyopathy, also known as Takotsubo cardiomyopathy or "broken heart syndrome," is an acute, transient, and often reversible left ventricular dysfunction triggered by emotional or physical stress. While classically seen in postmenopausal women after intense emotional distress, this case is notable for its onset following physical trauma (fall from height) without preceding emotional stress. It highlights the importance of considering stress cardiomyopathy in trauma patients presenting with chest symptoms, and adds to existing literature by reinforcing trauma as a valid trigger even in the absence of ECG changes.
Patient Concerns and Clinical Findings
A middle-aged female presented following a fall from the second floor, sustaining a fracture of the left lower limb. She developed sudden onset chest pain and dyspnea on exertion during hospitalization.
Key Clinical Findings:
Dyspnea on exertion
Chest pain following trauma
Normal ECG with mild ST-T changes
Elevated Troponin levels with disproportionately high NT-proBNP
Echocardiography:
Global hypokinesia of the left ventricle
Severely reduced ejection fraction (25%)
Severe mitral regurgitation
Normal right ventricular function
Elevated pulmonary artery systolic pressure

Diagnosis, Interventions, and Outcome
Diagnosis:
Stress cardiomyopathy (Takotsubo cardiomyopathy) secondary to physical trauma
Interventions:
Supportive cardiac management
Orthopedic management of limb fracture
Monitoring of cardiac biomarkers and functional recovery
Outcome:
By discharge, the patient showed marked improvement in cardiac function:
LVEF improved to 45%
Mitral regurgitation decreased to mild severity
Symptomatic improvement in dyspnea
Conclusion and Key Takeaways
This case underlines that physical trauma alone can precipitate stress cardiomyopathy, even in the absence of typical ECG findings or emotional triggers. A high index of suspicion, especially in trauma patients who develop unexplained dyspnea or chest pain, is essential. The rapid recovery of cardiac function emphasizes the reversible nature of this condition with timely diagnosis and supportive care.