A Case of Tacotsubo Cardiomyopathy - How We Uncovered the Diagnosis

Abstract

Introduction: Tacotsubo cardiomyopathu (TTC) is a stress-induced condition characterized by transient appical hypokinesia and is usually caused by stress-induced catecholamine release with toxic action that leads to stunning myocardium.

Methods and Results: The patient was a 62 year old woman without any history of heart disease and she admitted with chest pain and electrocardiography (ECG) with ST segment elevation in the precordial leads and troponins suggesting acute anterior myocardial infarction (MI). Emergency coronary angiography which is performed showed no significant coronary artery disease. Echocardiography showed reduced LV ejection fraction with left ventricular apical ballooning and (LV) thrombus. Cardiac magnetic resonance imaging showed localized hypokinesia of the mid septal segments and akinesis of all segments of the apex of the left ventricle and T2 hyperintesity consistent with myocardial transmural oedema in the same area with diffuse involvement. During the hospitalizasion patient was treated with single antiplatelet, anticoagulation therapy, diuretics, angiotensin-converting-enzyme inhibitors (ACE inhibitors) and beta blockers for treatment of heart failure reduced Ejection fraction (HFrEF). At 3 months follow up ECG was normal with reversal of symptoms and regression of wall motion abnormalities at echocardiography. According to investigation results, a diagnosis of tako­tsubo syndrome (TTS) was established.

Conclusion: Tako-tsubo cardiomyopathy often presents as an acute coronary syndrome with ST segment changes, as ST-segment elevation and/or T-wave inversion. Clinical presentation is characterized by acute coronary artery disease, in the absence of obstruction, verified by coronarography.Diagnostic methods are very important to make true decision of Tacotsubo cardiomyopathy.