Electronic ISSN 2287-0237

VOLUME

REVERSIBLE STRESS-INDUCED CARDIOMYOPATHY (TAKOTSUBO) MIMICS ACUTE ANTERIOR WALL ST SEGMENT ELEVATION MYOCARDIAL INFARCTION: A CASE REPORT WITH REVIEW OF LITERATURE

FEBRUARY 2016 - VOL.11 | CASE REPORT

We reported a transient stress-induced cardiomyopathy (SIC) in a 73-year-old woman who manifested with the setting of ST segment elevation myocardial infarction condition. She was initially complicated by heart failure from both systolic and diastolic dysfunction but had a fast recovery within 3 days. The trigger in this case was pneumonia of the right lower lung which responded well to medical therapy. The proposed pathophysiologic mechanisms and outcome had been reviewed. Currently, SIC was no longer considered a benign condition since the in-hospital complication rates were not different from those of ACS patients.

Keywords:

takotsubo, stress-induced cardiomyopathy, acute reversible heart failure, systolic and diastolic left ventricular dysfunction, pneumonia, anterior ST segment elevation myocardial infarction

MEDIA
Figure 1A-B:
1A: The first chest film showed some degree of body rotation, calcified aortic knob and infiltration at right lower lung field with mild pulmonary congestion. 1B: Chest film after endotracheal intubation showed improves lung expansion, proper tube position and unchanged right lower lung lesion.
Figure 2A-B:
2A: The 1st ECG showed sinus rhythm with ST segment elevation (STE) in leads V2-3, aVL and tall T in V4, 5. It should be noted that there was no STE in lead V1 which is common in the setting of acute anterior STE myocardial infarction. 2B: Serial ECG, 7 hours after symptom onset, showed more STE in V1-4, tall T in V5-6 and the serum potassium level was normal.
Figure 3A-C:
The first echocardiogram showed an akinetic wall beginning from distal septum to apical region, causing depressed left ventricular systolic function, LVEF of 0.35. Figure 3B: Serial echocardiogram on day 4 showed markedly improved apical wall and LVEF increased to 0.45. Figure 3C: On day-30, all wall motion appeared normal and LVEF was 0.60.
Figure 4A-C:
Coronary angiogram showed no significant luminal stenosis along the left main, left anterior descending, circumflex arteries, and the dominant right coronary arteries (4C).
Figure 5A, B:
Serial ECG showed and resolution of precordial ST segment elevation and T inversion on day-7 and day-30 with no Q wave development.
Figure 6A, B, C:
left ventricular diastole of another case. Figure 6B: apical ballooning during systole. Figure 6C: Japanese octopus pot.
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