An unexpected cause of acute coronary syndrome

Introduction: Takotsubo Cardiomyopathy, also called transient left ventricular apical ballooning or „broken heart syndrome” is a cardiac condition that mimics the clinical presentation of acute coronary syndrome, but without any evidence of obstructive atherosclero-tic coronary artery disease. Proposed etiopathogene-tic mechanisms include: multivessel coronary artery spasm, impaired cardiac microvascular function, and endogenous catecholamine induced myocardial st-unning and microinfarction.

Methods: We report the case of a 65 years old fema-le patient, with medical history of hypertension who was admitted two hours after the onset of an intense chest pain, associated which occurred in conditions of a major emotional stress. The electrocardiogram show-ed ST segment depression in precordial leads and deep t-wave inversions in both anterior and inferior leads, with positive finding of high sensitive cardiac troponin. The echocardiography showed severe impaired systolic function (estimated ejection fraction of 20-25%), with severe hypokinesia of the apex and also severe mitral regurgitation. The coronarography showed no signifi-cant coronary artery lesions and the left ventriculogra-phy showed severe hypokinesia of the apex, outlining an image of a left ventricle „apical ballooning”.

Results: Under supportive medical treatment, the evo-lution was slightly favourable, with symptoms relief and without arrhythmic events until discharge. accor-ding to the initial cardiovascular surgical evaluation, the mitral valve repair procedure was delayed, due to severe left ventricle systolic dysfunction. at four weeks follow- up, it was noticed a full recovery of the left ventricle function and mild mitral regurgitation at echo-cardiography.

Conclusions: This case underline an unexpected evo-lution of a critical patient, presented as acute myocar-dial infarction with severe left ventricular dysfunction and acute ischemic mitral regurgitation, but with „nor-mal” coronary arteries, that had instead an excellent recovery, typical for Tako- Tsubo Syndrome. Although it was thought to be a quiet rare condition, in the daily clinical practice this cardiomiopathy should be consi-dered on a patient presented as acute coronary syndro-me without significant coronary artery lesions.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)