Post-traumatic Takotsubo Cardiomyopathy in a Pediatric Patient: A Rare Case and Diagnostic Challenge

Abstract

Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is a rare condition in children that causes acute, severe, but often reversible systolic dysfunction of the left ventricle. Physical trauma is a recognized trigger, although distinguishing TTC from myocardial contusion in pediatric trauma cases can be challenging due to overlapping clinical features. We present the case of a six-year-old boy involved in a high-impact motor vehicle collision. The patient initially presented with multiple traumatic injuries, including fractures of the skull, ribs, and right upper extremity, as well as pulmonary contusions. After initial stabilization in the pediatric intensive care unit (PICU), he developed hemodynamic instability six hours postoperatively, with elevated troponin levels suggesting myocardial contusion. Echocardiography later revealed severe left ventricular dysfunction with apical akinesia and basal hyperkinesis, hallmark findings of TTC. Inotropic support was switched from dobutamine to milrinone to avoid exacerbating catecholamine-induced myocardial stress. Over seven days, the patient's left ventricular function normalized, with an ejection fraction of 55%, and he was discharged on day 15 in stable condition. This case highlights the importance of early recognition of TTC in pediatric trauma patients, where echocardiography and cautious use of inotropic agents can ensure optimal outcomes.