Complex case of Takotsubo cardiomyopathy

Cătălina Arsenescu-Georgescu, Mircea Balasanian, Nicușor Lovin, Larisa Anghel

Abstract


Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an unusual form of acute cardiomyopathy triggered by intense physical or emotional positive and negative stress. It involves left ventricular apical ballooning and mimics acute myocardial infarction. We present the case of a 74 year-old woman addressed to our clinic with the hypothesis of acute coronary syndrome in the context of T wave inversions in anterior leads associated with atypical chest pain and acute pain in the left lower limb.  She reported medical history of hypertension and repeated episodes of deep vein thrombosis with therapeutic limitations to anticoagulation and antiplatelet therapy because of the side effects. Due to high suspicion of acute coronary syndrome she underwent emergency coronary angiography, which revealed no significant coronary artery lesions but cardiac catheterization showed severe anterior-apical akinesia with compensatory infero-posterior hyperkinesis. This case report represents a diagnostic and also a therapeutic challenge because of the fortuitous diagnosis in the context of acute pain in the left lower limb which may cause confusion with the diagnosis of deep vein thrombosis. The acute pain in the left lower limb may also be considered the trigger factor for the Takotsubo cardiomyopathy in our patient.

Keywords


Takotsubo cardiomyopathy, coronary angiography, ventriculography

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References


Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002; 143:448-455.

Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004; 94:343-346.

Bybee KA, Murphy J, Prasad A, et al. Acute impairment of regional myocardial glucose uptake in the apical ballooning (Takotsubo) syndrome. J Nucl Cardiol 2006; 13:244-250.

Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or Takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006; 27:1523-1529.

Donohue D, Movahed MR. Clinical characteristics, demographics, and prognosis of transient left ventricular apical ballooning syndrome. Heart Fail Rev 2005; 10:311-316.

Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005; 128:296-302.

Arora A, Alfayoumi F, Srinivasan V. Transient left ventricular apical ballooning after cocaine use: is catecholamine cardiotoxicity the pathologic link? Mayo Clin Proc 2006; 81:829-832.

Inoue M, Shimizu M, Ino H, et al. Differentiation between patients with Takotsubo cardiomyopathy and those with anterior acute myocardial infarction. Circ J 2005; 69:89-94.

Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004; 141:858-865.

Kawai S, Kitabatake A, Tomoike H, et al. Guidelines for diagnosis of Takotsubo (ampulla) cardiomyopathy. Circ J 2007; 71:990-992.

Pellicia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo Syndrome. Circulation 2017; 135 (24):2426-2441.

Galiuto L, Badano L, Fox K, Sicari R, Zamorano JL. The EAE Textbook of echocardiography. Oxford University Press 2011.

Georgescu Arsenescu C, Floria M. Ghid de ecocardiografie transtoracica, volumul I. Editura Grigore T. Popa 2015. CNCSIS 229. ISBN 978-606-544-295-5.

Kurisu S, Inoue I, Kawagoe T, et al. Time course of electrocardiographic changes in patients with Tako-tsubo syndrome—comparison with acute myocardial infarction with minimal enzymatic release. Circ J 2004; 68:77-81.

Giordan M, Rigatelli G, Cardaioli P, et al. Angiographic long-term follow-up of primary apical ballooning of the left ventricle. Int J Card Imag 2006; 22:349-352.

Fazio G, Pizzuto C, Barbaro G, et al. Chronic pharmacological treatment in Takotsubo cardiomyopathy. Int J Cardiol 2008; 127:121-123.




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