Key result
Conservative management without revascularization in Takotsubo with significant CAD shows no 3-year recurrence.
Why the study?
Takotsubo cardiomyopathy is typically diagnosed by absence of significant coronary stenosis, but its association with significant coronary artery disease and atrioventricular conduction block is rarely reported.
Case Report (n=1)
This case highlights that Takotsubo cardiomyopathy can co-occur with significant coronary artery disease and high-degree atrioventricular block, suggesting coronary angiography should be performed in all suspected cases.
Suggests conservative management may suffice in select Takotsubo cases with heart block and stenosis; leaves open generalizability to larger populations.
INTRODUCTION: Takotsubo cardiomyopathy (TCMP) is a rare acute cardiomyopathy characterized by acute chest pain syndrome, similar to myocardial infarction, except that no significant stenosis is observed on coronary angiography in patients with this condition; these findings aid the diagnosis of TCMP. CASE PRESENTATION: We discuss an unusual case of TCMP in a 45-year-old woman with complete heart block and significant coronary artery stenosis. Maximal exercise test and perfusion scan after 1 month from the acute event did not show any ischemia; therefore, revascularization was not recommended. Her follow-up with normal echocardiographic data 3 years after the first event showed no recurrence. CONCLUSIONS: The present case and a few previous cases have showed that severe coronary artery disease may be occur in patients with TCMP and that TCMP may be associated with a high-degree atrioventricular block. The association between atrioventricular conduction block and TCMP as well as significant coronary stenosis is rarely reported; therefore, coronary angiography should be performed in all patients with clinical TCMP and the previous definition should be reconsidered. The occurrence of arrhythmia and later recovery is expected in these patients (due to a catecholamine surge).
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Saadatifar et al. (2015) conducted a case report in Takotsubo cardiomyopathy (n=1). Takotsubo cardiomyopathy with significant coronary stenosis and atrioventricular conduction block was evaluated on Recurrence of Takotsubo cardiomyopathy. A 45-year-old woman with Takotsubo cardiomyopathy, complete heart block, and significant coronary artery stenosis managed without revascularization had no recurrence at 3 years.
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