Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.677
Peer-review started: September 11, 2020
First decision: November 14, 2020
Revised: November 24, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 26, 2021
Processing time: 131 Days and 3.2 Hours
Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.
A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient’s hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.
Core Tip: Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, Takotsubo cardiomyopathy (TCM) should be considered in some clinical settings. Recurrent TCM triggered by emotional stress is rare. Early appropriate supportive treatments can avert adverse outcomes and ensure a good prognosis for patients with TCM. We hope that this case will increase our attention to the diagnosis of TCM.