Takotsubo cardiomyopathy in a Caucasian Italian woman: Case report

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Abstract

 

Abstract

Background: Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities (with peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levels

Case presentation: A 68-year-old woman was admitted to the Emergency Department because of sudden onset chest pain occurred while transferring her daughter, who had earlier suffered a major seizure, to the hospital. The EKG showed sinus tachycardia with ST-segment elevation in leads V2–V3 and ST-segment depression in leads V5–V6, she was, thus, referred for emergency coronary angiography. A pre-procedural transthoracic echocardiogram revealed regional systolic dysfunction of the LV walls with hypokinesis of the mid-apical segments and hyperkinesis of the basal segments. Coronary angiography showed patent epicardial coronary arteries; LV angiography demonstrated the characteristic morphology of apical ballooning with hyperkinesis of the basal segments and hypokinesis of the mid-apical segments. The post-procedural course was uneventful; on day 5 after admission the echocardiogram revealed full recovery of apical and mid-ventricular regional wall-motion abnormalities.

Conclusion: Takotsubo cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated. Acute stress has been indicated as a common trigger for the transient LV apical ballooning syndrome, especially in postmenopausal women. The present report is a typical example of stress-induced takotsubo cardiomyopathy in a Caucasian Italian postmenopausal woman.

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Background
Takotsubo cardiomyopathy, also known as transient left ventricular (LV) apical ballooning syndrome, is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities, chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme Published: 6 April 2007 Cardiovascular Ultrasound 2007, 5:18 doi:10.1186/1476-7120-5-18 Received: 24 March 2007 ccepted: 6 April 2007 This article is available from: http://www.cardiovascularultrasound.com/content/5/1/18 ├é┬® 2007 Lisi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.levels 1. The typical feature of the syndrome is a transient regional systolic dysfunction involving the LV apex and mid-ventricle with concomitant hyperkinesis of the basal LV segments 1. The syndrome has been first described in the Japanese population 2 and subsequently in the Caucasian population in both Europe 3 and U.S. 4, and was named takotsubo after a round bottomed narrow-necked Japanese fishing pot used for trapping octopus.

Case presentation
A 68-year-old woman was admitted to the Emergency Department because of sudden onset chest pain occurred while transferring her daughter, who had earlier suffered a major seizure, to the hospital. Her cardiovascular risk factors were female sex, tobacco smoking, dyslipidemia and family history of coronary artery disease. Upon admission her blood pressure was 150/80 mmHg and the electrocardiogram (EKG) showed sinus tachycardia with 2├óÔé¼ÔÇ£3 mm ST-segment elevation in leads V2├óÔé¼ÔÇ£V3 and 1 mm ST-segment depression in leads V5├óÔé¼ÔÇ£V6 (Figure 1). She was, thus, diagnosed with ST-elevation acute myocardial infarction and referred for emergency coronary angiography. A pre-procedural transthoracic echocardiogram revealed regional systolic dysfunction of the LV walls with hypokinesis of the mid-apical segments and hyperkinesis of the basal segments with ejection fraction (EF) of 40% (Figure 2A and 2B). Coronary angiography showed patent epicardial coronary arteries with no evidence of spasm or thrombosis and only minor atherosclerotic manifestations (Figure 3A and 3B); LV angiography demonstrated the characteristic morphology of apical ballooning with hyperkinesis of the basal segments and hypokinesis of the mid-apical segments (Figure 4A and 4B). Provocative tests for induction of coronary vasospasm were not performed. The patient was then transferred to the coronary intensive care unit for post-procedural continuous monitoring and started on oral aspirin, diltiazem, ramipril, atorvastatin and sub-cutaneous low molecular weight heparin. Results of laboratory analysis showed a peak serum Troponin Tlevel of 0.44 ng/ml (normality range 0.06├óÔé¼ÔÇ£0.1). EKG on day 1 after admission showed evolutionary T wave inversion in leads V2├óÔé¼ÔÇ£V3 with ST-segment normalization in leads V5├óÔé¼ÔÇ£V6 (Figure 5). On day 5 after admission the EKG showed persistent T wave inversion in leads V2├óÔé¼ÔÇ£V3 (Figure 6), while the echocardiogram revealed full recovery of apical and mid-ventricular regional wall-motion abnormalities with normal EF (Figure 7A and 7B). The post-procedural course was uneventful; takotsubo cardiomyopathy was the final diagnosis and the patient was, thus, discharged with a therapy consisting of aspirin, diltiazem, ramipril and atorvastatin. Conclusion Takotsubo cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated 1. Although the exact cause of the syndrome remains unknown, many underlying mechanisms have been, so

 

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References
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