Coexistence of Takotsubo cardiomyopathy and acute myocardial infarction

Takotsubo cardiomyopathy is one reversible heart disease, which presents as an acute myocardial infarction with ST-elevation in ECG. This Takotsubo Cardiomyopathy is one of the Cath laboratory diagnosis, that means, if the apical ballooning along with absence of obstruction of the corresponding coronary artery, then only the Takotsubo cardiomyopathy is diagnosed. But however there may be some exceptions. We describe a case of 80yr old male presenting the Emergency department with typical anginal symptoms for 3hours suggestive of acute myocardial infarction. The initial ECG demonstarted lateralwall Infarction. Serology revealed elevated cardiac Enzymes. As per the guidelines one emergency coronaryangiography was performed and revealed occluded Ramus diagonalis-2 and Plaque Rupture in mid segment of Right coronary artery, the ventriculography confirmed apical ballooning consistent with takotsubo cardiomyopathy and not in the vascular territory supplied by the occluded epicardial vessel. Traditionally, the Takotsubo Cardiomyopathy is labelled as a diagnosis only in absence of the obstruction of the corresponding coronary artery. This case however reflects the coexistence of the obstructed coronary artery and the takotsubo cardiomyopathy and moreover in a male, so the diagnostic criteria for Takotsubo cardiomyopathy my need a prompt review and this case definitely adds to the number of coexistence.