A Case of Takotsubo Cardiomyopathy - How We Uncovered the Diagnosis

Introduction: Takotsubo cardiomyopathy (TTC) is a stress-induced condition characterized by transient apical hypokinesia and is usually caused by stress-induced catecholamine release with toxic action that leads to stunning myocardium. The aim of this report is to present the female patient with takotsubo cardiomyopathy with clinical presentation, diagnosis, treatment and follow up of this condition. This patient has good prognosis with complete left ventricular systolic function recovery typically occurring within weeks.

Methods and Results: The patient was a 62 years old woman without any history of heart disease. She was admitted with chest pain and electrocardiography (ECG) with ST segment elevation in the precordial leads and troponins suggesting acute anterior myocardial infarction (MI). The urgent coronary angiography which is performed didn’t show obstructive coronary lesions. Echocardiography showed reduced left ventricle (LV) ejection fraction with LV apical ballooning and LV thrombus. Cardiac magnetic resonance imaging (MRI) 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 2 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: Takotsubo 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 takotsubo cardiomyopathy and coronary angiography and cardiac MRI are the best.