Cardiac arrest due to ventricular fibrillation in a 23-year-old woman with broken heart syndrome

Broken heart syndrome, also known as takotsubo cardiomyopathy, is a syndrome characterized by a transient regional systolic dysfunction of the left ventricle associated to a psychological stress. We herein describe a case of a 23-year-old female habitual marijuana user who was resuscitated after cardiac arrest and then diagnosed with midventricular stress cardiomyopathy complicated by subendocardial hemorrhage. We discuss this unique pathological finding, the incidence of arrhythmias in this syndrome, and the possible relation with chronic cannabis and tobacco use. Unfortunately, the patient did not survive, but had she survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease. •The age of onset was unusual at 23 years, and it may be related to cannabis use, a newly identified risk factor.•The autopsy showed subendocardial hemorrhages, providing a further insight in this poorly understood disease.•Ventricular fibrillation was the presenting scenario, and this is quite unusual.•If patient had survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease.