Stress cardiomyopathy - Takotsubo
| Case description: Mimicking myocardial infarction by a stress cardiomyopathy
An 81-year-old woman with no cardiac history presented with acute chestpain which radiated to the left arm. The blood pressure was 140/80 mmHg and a heart rate of110/min. Physical examination revealed no abnormalities. The electrocardiogram was compatible with acute anterior myocardial infarction. (A) Immediate coronary angiography showed normal coronary arteries (B and C). A left ventricular (LV) angiogram revealed a Tako-tsubo-like cardiomyopathy, recognized by a hypercontractile base and a bulging out of the LV-apex at systole (D), which normalizes at diastole (E). This typical LV-angiogram resembles a local octopus trap in Japan , where this cardiomyopathy was first described. Although clinical presentation can be quite severe, prognosis is usually good with complete LV recovery. It occurs commonly in post-menopausal woman, usually provoked after extreme emotional stress. In a second interview, the patient told she had a severe emotional experience at a parking lot that morning, after which she developed chestpain.
|Courtesy of: Courtesy of M. Meuwissen, MD, PhD, AMC, The Netherlands|
|Figure A: Electrocardiogram||Movie B: Angiography RCA|
|Movie C: Angiography LCA||Movie D: Left ventricular angiography|
|Image E: Still frames of left ventricular angiography at end systole and end diastole|