A rare case of left ventricular cardiac rupture in the acute phase of takotsubo syndrome.

Takotsubo syndrome (TTS), often triggered by emotional or physical stress, is characterized by transient left ventricular dysfunction that mimics acute coronary syndrome. We present a case involving an 85-year-old woman with a history of atrial fibrillation who developed sudden severe chest pain during sleep. Initial evaluation suggested ST elevation myocardial infarction; however, emergency coronary angiography revealed patent coronary arteries, leading to a diagnosis of TTS. Immediately after angiography, the patient experienced sudden loss of consciousness, which resulted in death with diminished circulating plasma volume. Autopsy confirmed mid-antero-septal wall rupture with massive left pleural thrombus, suggesting cardiac rupture due to TTS as the cause of death. Our case represents a rare case of TTS complicated by cardiac rupture in the ultra-acute phase, highlighting the critical importance of early recognition and urgent intervention in high-risk patients. Learning objective: Takotsubo syndrome (TTS) usually has a favorable prognosis but can cause severe complications such as cardiogenic shock, left ventricular outflow obstruction, and, rarely, cardiac rupture (CR). Although uncommon, CR is life-threatening and requires vigilance in high-risk patients. This case highlights the critical importance of early recognition and urgent intervention in high-risk patients with TTS to prevent catastrophic outcomes.