Takotsubo cardiomyopathy, which was first described in Japan in 1990 [
1], is characterized by transient dysfunction of the medial to apical segment of the left ventricle. The word takotsubo relates to a special shaped pot (octopus pot) and is used to describe the characteristic ballooning of the left ventricular apex [
1]. It mostly affects elderly women and is often preceded by emotional or physical event; however, the cause of takotsubo cardiomyopathy has not been fully elucidated [
1]. Takotsubo cardiomyopathy is often clinically diagnosed and the Mayo Clinic diagnostic criteria are widely used for this purpose [
2,
3]. According to these diagnostic criteria, obstructive coronary disease, pheochromocytoma and myocarditis should be excluded. New electrocardiographic abnormalities, such as ST-segment elevation or elevation in cardiac troponin are observed. Reported recurrence rates range from 0 to 15% [
4‐
8]. Although a few papers reported that the earliest time of recurrence was 8 days [
4,
6], in most cases, a relapse occurs within a few months or years [
1,
4,
6,
9‐
13]. Severe complications, including arrythmia, acute cardiac shock and cardiac rupture may arise [
1,
4,
14‐
18]; however, takotsubo cardiomyopathy is typically a reversible functional disorder and autopsy cases are rare [
19]. In most cases, macroscopic study of the heart shows focal damage, such as rupture, or the absence of structural change [
20,
21]. Histologically, contraction band necrosis of the myocardium is commonly recognized [
14,
15,
20‐
22], and a few papers have described thinning of the myocardium or interstitial fibrosis of the heart [
17,
19,
20,
22].
We report a notable autopsy case of takotsubo cardiomyopathy with several episodes of recurrence within 2 weeks before death, which broadly presented severe irreversible myocardial damage.