Reversed takotsubo cardiomyopathy in a patient with new-onset multiple sclerosis: Cause, link, or just coincidence?

A 29-year-old man with no prior medical history presented to the emergency department with acute chest pain and sudden onset of severe headache. He was alert and oriented. Physical examination revealed hypertension (192/100 mmHg). The patient underwent an urgent computed tomography (CT) scan of the head, which demonstrated a hypodense lesion in the right frontal lobe of the brain, which was later confirmed to be a demyelination lesion related to multiple sclerosis (MS) (Supplementary Fig. 1). The ECG showed no significant abnormalities (Fig. 1A). Patient laboratory findings demonstrated elevated troponin T levels (0.082 μg/L, reference < 0.014 μg/L) and normal CK–MB. Transthoracic echocardiography (TTE) displayed normal left ventricular function with no wall motion abnormalities (Supplementary Video 1). The combination of normal ECG and TTE, and his young age, the subtle rise in troponin was suspected to be related to hypertension. After pharmacological treatment of hypertension, his chest pain resolved, and after 10 days the patient was discharged in good clinical condition.