3/2/2024 0 Comments Diffuse timi 3 flow1A) when compared with a routine ECG from a year earlier ( Fig. An echocardiogram 2 months later showed complete recovery of LV function and no regional wall-motion abnormalities.Īt the current presentation-the patient's 4th episode with chest discomfort-ECG showed new, diffuse ST-segment elevation in the anterolateral and inferior leads ( Fig. The OM stent was patent, and no new lesions had developed since the earlier angiography. At that time, a left ventriculogram showed moderate LV dysfunction with apical akinesis, again consistent with takotsubo cardiomyopathy. In 2003, she had a 3rd episode of chest pain, after a family quarrel. Subsequent echocardiography revealed that the patient's LV function had returned completely to normal. The left ventriculogram showed apical hypokinesis that was consistent with takotsubo cardiomyopathy, in that the regional wall-motion abnormality did not correspond with the region of the stenosed coronary artery however, that diagnosis was not considered at the time, in part because takotsubo cardiomyopathy had not yet been widely recognized in the medical literature. It showed severe stenosis of the 1st obtuse marginal branch (OM) with Thrombolysis in Myocardial Infarction (TIMI)-3 flow this was treated by means of percutaneous coronary intervention. Due to ST-segment elevation in leads I and aVL on electrocardiography (ECG), angiography was repeated. She had no further cardiac problems until 1999, when she again had chest pain. Although it was not recognized at the time, the LV apex showed akinesis that was consistent with takotsubo cardiomyopathy. She had experienced a similar episode in 1992, presenting with chest pain on angiography, her coronary arteries had shown no severe stenosis. Her family reported that she had been emotionally distressed 2 days prior, on the anniversary of her husband's death. In 2010, an 84-year-old woman emergently presented with chest pain, which was partially relieved by nitroglycerin. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch.Īlthough this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. Indeed, previous investigators have found incidental stenosis in only a minority of patients. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels.
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