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INTRODUCTION: Takotsubo ("Tako-tsubo" meaning "octopus trap" in Japanese) cardiomyopathy, also known as stress-induced cardiomyopathy, ampulla cardiomyopathy, or more known as "broken heart" syndrome, is a rare form of reversible non-ischemic cardiomyopathy that is characterized by transient regional systolic dysfunction along with apical akinesis and ballooning.It often mimics acute myocardial infarction with minimal troponin elevations.There are other variants of Takotsubo in which there may be mid-left ventricular, basal akinesia, or hypokinesia with apical sparing.The pathophysiology of how this occurs is elusive.It is hypothesized that the surge of catecholamines causes an upregulation of beta-adrenergic receptors, resulting in overall regional dysfunction of the myocardium.Here, we demonstrate an interesting case of Takotsubo cardiomyopathy following a gastrointestinal bleed. CASE PRESENTATION:A 71-year-old male with a past medical history of metastatic prostate cancer to the bone, hypertension, hyperlipidemia, type 2 diabetes mellitus, and chronic kidney disease presented to the hospital via emergency medical services from an assisted living facility for dyspnea.In the ED, the patient was hypoxic in the 70s and refractory to bag valve mask.He was intubated, sedated, required pressor support, and transferred to the ICU.Labs on admission were significant for a hemoglobin of 4.3 that improved with blood transfusions.Esophagogastroduodenoscopy (EGD) was done and showed non-active bleeding ulcers.The patient was off pressors and clinically stable with no more signs of active bleeding.He was extubated and suddenly started to have episodes of melanotic stools and frank blood in the orogastric suction, which unfortunately led to cardiac arrest.CPR was initiated, and return of spontaneous circulation was achieved.Post cardiac arrest, the patient required pressors and was continuously having episodes of bleeding.Repeat EGD showed multiple ulcers and clips were placed.The patient started to improve, still required pressors, but was continuing to be weaned off gradually.During the workup of the patient's cardiac arrest, he was found to have a hemoglobin of only 6.5 and uptrending troponin levels.Echocardiography reported hypokinesis of all wall segments except for basal segments and an ejection fraction of 30%, consistent with Takotsubo cardiomyopathy.DISCUSSION: Our patient presented with acute blood loss anemia in the setting of gastrointestinal bleeding.The most widely accepted hypothesis for the pathophysiology of how Takotsubo cardiomyopathy occurs is that after a stress-inducing event, there is a sudden outpouring of plasma catecholamines, their metabolites, and neuropeptides (norepinephrine, epinephrine, and dopamine) that cause a "myocardial stunning" in which produces a negative inotropic effect and overall left ventricular dysfunction.For most individuals, it resolves within a few weeks after onset.The criteria for diagnosing Takotsubo include no known evidence of coronary artery disease and any evidence of ST segment elevations and/or T wave inversions on electrocardiogram.Echocardiography is vital for diagnosis as it allows the healthcare provider to assess wall motion abnormalities.CONCLUSIONS: Takotsubo cardiomyopathy is a rare condition caused by the surge of catecholamines after a stress-inducing event.In this case, the healthcare provider needs to consider gastrointestinal bleeding as a precipitating factor for the onset of Takotsubo cardiomyopathy.