Acute NSTEMI triggering Takotsubo syndrome in an 84-year-old female resulted in cardiogenic shock, followed by complete resolution of wall motion abnormalities and LVEF recovery to 50-55% at 6 weeks.
Case Report (n=1)
Acute myocardial infarction can trigger Takotsubo syndrome, and recognizing this overlap is important as the Takotsubo-related dysfunction is often fully reversible.
Abstract Introduction Takotsubo cardiomyopathy is a transient, reversible left ventricular systolic dysfunction that mimics acute coronary syndrome (ACS) but occurs without any obstructive coronary artery disease (CAD). We present a peculiar case where a patient presenting with ACS progressed to develop Takotsubo syndrome (TTS). Case report An 84 year old female with past medical history of hypertension, hyperlipidemia, prior CAD with stents, Heart failure with preserved ejection fraction, Chronic kidney disease stage IIIB, hypothyroidism and congenital deafness developed sudden onset squeezing chest pressure and dyspnea. On arrival, her vitals were Blood pressure of 126/62 mmHg, Heart rate of 110 bpm, SpO2 of 94% on room air. Physical examination revealed bibasilar crackles and bilateral pedal edema. Laboratory testing revealed troponin of 243 ng/L trending to 36,000 ng/L, Creatinine of 1.30 mg/dl and moderately elevated BNP. Imaging ruled out any pulmonary embolism, showed cardiomegaly and vascular congestion. Initial EKG showed ectopic atrial tachycardia with incomplete left bundle branch block which progressed to deep T wave inversions across V2 - V6, lead I and aVL. Echo showed left ventricular ejection fraction (LVEF) of 30 - 35%, apical and anterior hypokinesis and the dysfunction distribution exceeded expectations for isolated Right Coronary Artery (RCA) infarction. Immediate coronary angiography revealed subtotal proximal RCA occlusion and was treated with stenting, non flow limiting 50% mid LAD stenosis with patent left main and circumflex arteries. Post catheterization, the patient developed cardiogenic shock requiring intra aortic balloon pump along with vasopressors. Post operative echocardiogram showed LVEF of 45 - 50% with improving wall motion abnormalities. At 6 weeks, patient showed complete resolution of prior noted wall motion abnormalities with an ejection fraction of 50 - 55%. Discussion and clinical importance The marked troponin rise, culprit RCA lesion confirmed Acute NSTEMI (Non ST segment elevation myocardial infarction) however the degree of apical and anterior hypokinesis far exceeded the RCA territory and the rapid complete recovery favored reversible stunning consistent with TTS precipitated by acute myocardial infarction (MI) and shock. The InterTAK score was estimated at 50 which supports intermediate probability for TTS supporting but not proving TTS in this overlap context.Classic TTS criteria (Mayo Clinic Criteria) can obscure recognition of overlap presentations. Use of the InterTAk score and multimodality imaging like cardiac MRI can improve discrimination between scar tissue and reversible injury. Recognizing TTS related dysfunction in the context of this overlap refines prognosis since the condition is often fully reversible. This abstract is funded by: Self
Madine et al. (Fri,) conducted a case report in Acute Coronary Syndrome and Takotsubo Syndrome (n=1). Coronary angiography with stenting, intra-aortic balloon pump, and vasopressors was evaluated. Acute NSTEMI triggering Takotsubo syndrome in an 84-year-old female resulted in cardiogenic shock, followed by complete resolution of wall motion abnormalities and LVEF recovery to 50-55% at 6 weeks.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: