Abstract
BackgroundIntegrated bedside and sophisticated cardiac imaging techniques help characterize the discrepancy between myocardial injury and mechanic dysfunction in acute myocardial infarction.Case presentationA 57 year-old woman presented with sudden onset chest pain and ventricular fibrillation after hearing of her brother’s death. The electrocardiography indicated “anterior wall ST segment elevation myocardial infarction”. Coronary angiography ruled out obstructive lesion in the major coronary arteries, but revealed fibromuscular dysplasia of the distal left anterior descending artery. The ventriculography showed remarkable ventricular dilation, which affected much broader myocardium than the culprit vessel supplied. In a subsequent cardiac magnetic resonance study, delayed contrast (gadolinium) image revealed a focal left ventricular (LV) apical infarction. Her LV systolic function normalized within 1 week, except for a residual apical hypokinesis. She developed recurrent chest pain and LV dilation when she was laid off 9 months later. After supportive therapy, her symptoms improved and LV dysfunction normalized again.Conclusions“Tako-tsubo” syndrome can occur recurrently in the heart with pre-existing localized myocardial infarction. Its molecular mechanism and clinical significance warrants further investigation.
Highlights
Integrated bedside and sophisticated cardiac imaging techniques help characterize the discrepancy between myocardial injury and mechanic dysfunction in acute myocardial infarction.Case presentation: A 57 year-old woman presented with sudden onset chest pain and ventricular fibrillation after hearing of her brother’s death
Background its clinical manifestation often mimics that of an acute anterior wall myocardial infarction (MI), Takotsubo syndrome (TTS) was postulated to have completely different etiology, pathophysiology and prognosis [1, 2]
As more real-time cardiac imaging, bedside echocardiography, are applied, TTS have been frequently identified in patients with coexisting coronary artery disease
Summary
Its clinical manifestation often mimics that of an acute anterior wall myocardial infarction (MI), Takotsubo syndrome (TTS) was postulated to have completely different etiology, pathophysiology and prognosis [1, 2]. As more real-time cardiac imaging, bedside echocardiography, are applied, TTS have been frequently identified in patients with coexisting coronary artery disease. Multi-modality imaging evaluation help characterize the discrepancy between myocardial injury and ventricular mechanic dysfunction during TTS and MI. Case presentation A 57 year-old woman presented with sudden onset chest pain/ventricular fibrillation after hearing of her brother’s. One week later, repeated transthoracic echocardiography (TTE) showed nearly normalized LV systolic function except for a residual apical hypokinesis (Fig. 1h–n) compared with original episode (Fig. 1g–m). Nine months later, when she was laid off, she developed recurrent chest pain and significant LV dilation, with different contractile pattern (Fig. 1i–o). Both her symptoms and LV dysfunction spontaneously improved quickly
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