Takotsubo cardiomyopathy in a Caucasian Italian woman: Case report

Matteo Lisi,Valerio Zacà,Carlo Pierli,Roberto Favilli,Silvia Maffei,Debora Castellani,Francesca Casucci,Stefano Lunghetti,Paolo Aitiani,Arcangelo Carrera,Marianna Maggi,Sergio Mondillo

doi:10.1186/1476-7120-5-18

Abstract

BackgroundTakotsubo 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 levelsCase presentationA 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.ConclusionTakotsubo 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.

Highlights

Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient left ventricular (LV) regional wall motion abnormalities, chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levelsCase 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
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
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)

Summary

Conclusion

Takotsubo cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated [1]. The exact cause of the syndrome remains unknown, many underlying mechanisms have been, so TFiwgeulrve-l1ead electrocardiogram on admission Twelve-lead electrocardiogram on admission. It has been reported that the majority of patients experiencing the syndrome were post-menopausal Japanese women who CFiogruornear3y angiography Coronary angiography. In general different series) with a mean age at presentation of TFiwgeulrve-l5ead electrocardiogram on day 1 after admission Twelve-lead electrocardiogram on day 1 after admission. Desmet et al in 2003 first described the syndrome in a series of 13 Caucasian patients from Belgium [3]; more recently other groups from both North America and Europe reported series of LV apical ballooning in white women, the largest, by Sharkey et al, involving 22 subjects [1,4,6,7]. The present case is a typical example of stress-induced takotsubo cardiomyopathy in a Caucasian Italian postmenopausal woman

Background