A Whodunnit: Anterior ST-Elevation Myocardial Infarction in a Patient Found to Have Apparent Takotsubo Cardiomyopathy, Left Anterior Descending Artery Disease, and Myocardial Bridging

Figures

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  Figure 1. ECG showing ST elevation in leads V2 and V3 (red arrows).

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  Figure 2. Coronary angiography of proximal left anterior descending artery lesion (red arrow).

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  Figure 3. Post-percutaneous coronary intervention ECG with resolution of ST elevation in leads V2 and V3 (red arrows).

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  Figure 4. Apical four-chamber view on transthoracic echocardiogram with diastolic phase on the left (A) and systolic phase on the right (B). The red outline shows classic apical akinesis with basilar sparing and left ventricular dilatation.

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  Figure 5. ECG showing recurrent ST elevation in leads V2 and V3 associated with chest pain after administration of nitroglycerin.

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  Figure 6. Coronary angiography showing a diastolic phase on the left (A) and a systolic phase on the right (B) with decreased vessel caliber in the mid to distal left anterior descending artery (red arrows).

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  Figure 7. Sagittal view of cardiac MRI on the left showing late gadolinium enhancement (red arrows) with black core (yellow arrow) in the anteroseptal wall of the left ventricle suggestive of myocardial ischemia with microvascular occlusion.