Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy

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Statistical analysis
Values are expressed as mean ± standard deviation (SD) unless indicated otherwise. Groups were compared by parametric or non-parametric tests (t-tests and Wilcoxon-Mann-Whitney tests, respectively). More than 2 groups were compared using the analysis of variance. Post-hoc tests were performed (if significant differences were proved globally) with the help of Newman-Keuls test. A p < 0.05 was considered as statistically significant.

Results
Demographic and clinical features of the study patients are reported in Table 1. All patients reported a physical and/or an emotional distress in the hours immediately before admission consisting of death of a relative in 4, strong financial loss in 1 and heated argument with daughter in 1. The presenting symptoms were chest pain in 6, dyspnea in 2, lipotimia in 1 and severe dyspnea with acute heart failure in 1 patient. The initial electrocardiogram showed sinus rhythm in all patients with ABS, with a median heart rate of 105 beats per minute; 3 patients had ST-segment elevation of at least 1 mm, and 3 patients had diffuse T-wave inversion; 3 patients had a prolonged QT interval corrected for heart rate (QTc). Q waves did not appear in any of the observed patients. On admission, echocardiogram showed an apical dysfunction in all of the patients. Over time, there was a normalization of regional wall motion (Figure 1), a reduction of left ventricular end-systolic volume and improvement of diastolic function (Table 2).
 

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Figure 1: A typical echocardiographic appearance of apical ballooning syndrome. Left up: end-diastolic image on admission and left down end-diastolic image at discharge; right up: end-systolic image on admission and right down: end-systolic image at discharge.

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