A 63-year-old man presenting with clinical features mimicking Takotsubo cardiomyopathy was diagnosed with acute myocardial infarction due to a wrap-around right coronary artery occlusion and successfully treated with percutaneous coronary intervention.
Case Report (n=1)
No
This case highlights the importance of performing coronary angiography to differentiate acute myocardial infarction with a wrap-around right coronary artery from Takotsubo cardiomyopathy, as their clinical and ECG presentations can be indistinguishable.
BACKGROUND: Takotsubo cardiomyopathy (TC) is a cardiomyopathy that shows distinctive clinical conditions first described more than 20 years ago. Because clinical features of TC mimic those of anterior acute myocardial infarction (AMI), the differential diagnosis is important in selecting the appropriate treatment strategy in the acute phase. But it was difficult to differentiate those two diseases because the TC-like findings; such as the electrocardiogram (ECG) changes and left ventricular wall motion abnormality can occur in AMI especially with the anatomical variance of the coronary artery. CASE PRESENTATION: A 63-year-old man was admitted due to sudden onset of chest pain and was in a cardiogenic shock state. His ECG showed ST-segment elevation in precordial (V2-6) and inferior leads (II, III, and aVF) and ST-segment depression in lead aVR. Blood biochemistry showed that cardiac enzymes were not elevated. Ultrasonic cardiography showed that the left ventricular apical level was akinetic, papillary muscle level was severely hypokinetic, and basal level was hyperkinetic, mimicking TC. However, coronary angiogram showed total occlusion of his right coronary artery wrapping around the cardiac apex. Successful percutaneous coronary intervention reversed his critical status. CONCLUSION: To our knowledge, the present case is the first report described AMI with wrap-around RCA, mimicking TC. Although TC is increasingly recognized as a true but relatively infrequent clinical entity, it is still important to carefully rule out obstructive coronary artery disease.
Shibutani et al. (Thu,) conducted a case report in Acute myocardial infarction mimicking Takotsubo cardiomyopathy (n=1). Percutaneous coronary intervention was evaluated. A 63-year-old man presenting with clinical features mimicking Takotsubo cardiomyopathy was diagnosed with acute myocardial infarction due to a wrap-around right coronary artery occlusion and successfully treated with percutaneous coronary intervention.
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