433 A Case of Concurrent Takostubo Cardiomyopathy and Spontaneous Coronary Artery Dissection

Abstract

Takotsubo’s cardiomyopathy and spontaneous coronary artery dissection (SCAD) are important non-atherosclerotic causes for acute coronary syndrome (ACS) to consider in young people presenting with ACS. They share similar epidemiological features (younger age of onset and female preponderance) and are thought to be driven by similar hormonal/ sympathetic pathways. Despite this, there have been few cases where both SCAD and Takotsubo presented together. A 56 year old woman presented to a regional hospital with an inferior ST segment elevation myocardial infarct. She was a distant ex-smoker, and had well controlled hypertension. Cardiac troponins were elevated to 13,557 ng/L. She proceeded to have trans-thoracic echocardiography (TTE) which demonstrated moderate apical hypokinesis and ballooning. Coronary angiography noted severe tubular stenosis to the distal left circumflex artery. The left ventriculogram showed pathognomonic findings of Takotsubo’s cardiomyopathy with apical ballooning and hyperdynamic basal function. Medical management was commenced, with the use of dual antiplatelets, cardioselective beta- blockers, and angiotensin converting enzyme inhibitors. Repeat coronary angiogram 4 weeks following initial presentation demonstrated resolution of her SCAD findings and apical ballooning syndrome. This case describes a rare presentation of concomitant SCAD and Takotsubo cardiomyopathy, describing our management approach to this presentation and its effective outcome. The case highlights similarities in the underlying pathophysiology of these conditions and raises questions to be addressed in future studies.