Sudden death in a case of recurrent Takotsubo syndrome

  • Chiara Toni
  • Francesca Iannaccone
  • Piersilvio Chella
  • Fulvio Basolo
  • Angela PucciEmail author
Case Report


Herein we report an unusual case of sudden death occurring in a 65 year old woman during a minor oral surgery. The subject, who had a medically treated anxiety, had a history of two reversible left ventricle dysfunction episodes consistent with recurrent Takotsubo Syndrome that had occurred seven and six years before, respectively. She also suffered from moderate, well treated post-menopausal systemic hypertension. Post-mortem examination showed apical biventricular ballooning of the heart with no cardiac rupture, coronary artery lesion or other cardiac/extra-cardiac disease. Toxicological tests and forensic investigations excluded unnatural causes of death, including pharmacological or iatrogenic causes related to medical malpractice. Only non-specific contraction bands and mild hypertrophy were observed by histology in the left ventricle myocytes. Takotsubo syndrome is usually an acute and reversible heart failure syndrome with acute left ventricle apex ballooning, no coronary artery disease or other macroscopic or microscopic cardiac changes; physical or emotional stress are well known triggering factors. Nevertheless, recurrent forms, major cardiac adverse events and even sudden death may occur in a minority of cases, meaning that a diagnosis of Takotsubo syndrome must be considered in cases of sudden death and in forensic investigations.


Sudden death Takotsubo syndrome Stress cardiomyopathy Apical ballooning Forensic autopsy Histopathology 



This study received no funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Forensic Medicine DepartmentPisa University HospitalPisaItaly
  2. 2.Cardiology DepartmentPisa University HospitalPisaItaly
  3. 3.Histopathology DepartmentPisa University HospitalPisaItaly

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