The Stressed Heart: Takotsubo Cardiomyopathy Following Percutaneous Coronary Intervention

Takotsubo cardiomyopathy, otherwise known as “stress cardiomyopathy,” “apical ballooning syndrome,” or “broken heart syndrome,” is a transient dysfunction of the left-sided ventricle associated with stress, and it is often confused with acute myocardial infarction on an electrocardiogram. Diagnosis is made by excluding coronary artery disease by coronary angiography and followed by left ventricular angiography, which shows the pathognomonic apical ballooning characteristic of Takotsubo cardiomyopathy. This is a case of a 61-year-old female who presented with anterior wall myocardial infarction. A coronary angiogram showed a tight lesion in the ramus intermedius, and she underwent percutaneous coronary intervention to the ramus intermedius. On Day 2, she had chest pain, with an electrocardiogram showing re-emerging ST-elevation in the precordial leads, raising suspicion of stent thrombosis. Coronary angiography and left ventricular angiography showed a patent stent and features consistent with Takotsubo cardiomyopathy. Re ST-elevation following percutaneous coronary intervention is concerning, as there is a high chance of stent thrombosis in such patients. Takotsubo cardiomyopathy should be strongly suspected as one of the differential diagnoses, especially in elderly postmenopausal females who present with ST-segment elevation with a history of physical or emotional stress. Takotsubo cardiomyopathy following percutaneous coronary intervention is a very rare clinical entity, and its clinical presentation is often confused with complications arising from percutaneous coronary intervention.