Takotsubo cardiomyopathy after pacemaker implantation

A 72-year-old female patient was admitted to hospital due to second degree and intermittent third degree atrioventricular block (AVB) . The DDD pacemaker was implanted successfully. After the procedure, the patient had chest pain and shortness of breath. Troponin T (TnT) was elevated gradually and the electrocardiography showed T wave inversion. The coronary angiography showed mild leisons and left ventriculography identified Takotsubo cardiomyopathy. Echocardiography showed reduced left ventricular ejection fraction (LVEF). It was confirmed eventually that the pain, nervousness and anxiety during the procedure of pacemaker implantation triggered the problem. After medical therapy, the left ventricular wall motion and LVEF was recovered normal.