Tight coronary artery stenosis and takotsubo syndrome triggered each other: Well-illustrated in a case

Abstract

Post-ischemic myocardial stunning (PIMS) is defined as a prolonged and reversible left ventricular dysfunction induced by an acute coronary ischemic insult. Takotsubo syndrome (TS) is a recognized acute cardiac disease entity, characterized by a unique pattern of transient circumferential left ventricular wall motion abnormality (LVWMA). The LVWMA in TS has all the characteristic features of myocardial stunning. Herein, the case of a 76-year-old woman with severe three-vessel coronary artery disease presented with acute coronary syndrome inducing PIMS with features identical to mid-apical pattern of TS is reported. The stunned myocardium caused incessant (throughout systole and diastole) compression of a segment of left anterior descending artery (LAD) with myocardial bridging during the acute and sub-acute stages of the disease. The systo-diastolic compression of LAD was relieved after recovery of LVWMA 26 days later. This novel observation suggests that the myocardial stunning in TS is in a cramp state during the acute and sub-acute stages of the disease. The cramp state of myocardial stunning may also explain the microvascular dysfunction seen in some patients with TS.