Metastatic ovarian cancer presenting as takotsubo cardiomyopathy: A case report

A 65-year-old female presented with 2 weeks of dyspnoea, associated with orthopnoea and lower limb pitting edema. There were no prior major physical or emotional stressors. Initial investigations showed elevated N-terminal pro-B-type natriuretic peptide (NT-ProBNP), Troponin-I and dynamic ST-T changes on electrocardiogram. Coronary angiography was normal and echocardiography demonstrated apical akinesis and ballooning with normokinesis of the base of the left ventricle. A diagnosis of Takotsubo cardiomyopathy (TC) was made. The patient was initially treated for heart failure as well but a thoracentesis of pleural fluid demonstrated adenocarcinoma. Computed tomography revealed newly diagnosed metastatic ovarian adenocarcinoma. To our knowledge, TC as a presentation of undiagnosed metastatic ovarian cancer has not been reported before and we believe that this case adds to the growing literature of the link between TC and cancer.