*Purpose: Takotsubo cardiomyopathy also known as apical ballooning syndrome and stress-induced cardiomyopathy is a syndrome characterized by regional left ventricular systolic dysfunction that resembles myocardial infarction in its initial presentation, however it lacks angiographic evidence of coronary artery disease. We evaluated the incidence of Takotsubo cardiomyopathy following liver transplantation at a diverse urban transplant program.

*Methods: A retrospective review of patients transplanted at a single center between 2017-2019. Here we report 2 cases of Takotsubo cardiomyopathy developing following liver transplantation.

*Results: A 65-year-old female diagnosed with alcoholic cirrhosis underwent a brain-dead donor liver transplant. The post-operative course involved a prolonged ICU stay and multiple hospital admissions for stroke, pulmonary hypertension, diarrhea, urinary tract infection, and a left internal jugular thrombus. 6 months following transplant, the patient developed Takotsubo cardiomyopathy with congestive hepatopathy and passed away from heart failure complications despite maximal medical care. The second case was a 60-year-old female diagnosed with alcoholic cirrhosis who was admitted for a living donor liver transplant. The immediate post-operative period involved recurrent seizures that were medically controlled. 10 days post-transplant the patient was found to have elevated troponins and markedly reduced ejection fraction that were appropriately managed. The patient recovered well with supportive care and was discharged to a rehab facility shortly after.

*Conclusions: We present a series of patients with Takotsubo cardiomyopathy after liver transplantation. The diagnosis depends on the clinical presentation and findings on electrocardiography, echocardiography, and cardiac enzymes. Our patients met the mayo clinic diagnostic criteria and were appropriately managed according to guidelines. Our report highlights the possibility of pulmonary hypertension contributing to the development of Takotsubo cardiomyopathy, further studies are needed to establish a definitive correlation.

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