Variant of Takotsubo Cardiomyopathy with Co-Existent Severe Coronary Artery Disease – A Case Report

Case PresentationA 73 year old hypertensive female admitted with sudden onset intermittent chest pains and shortness of breath (< 24 hours after the death of her granddaughters in a road traffic accident).There were no other significant past medical history of note and she never smoked.On arrival, she was tachycardic (heart rate 102) in sinus rhythm, normotensive and clinical examination was unremarkable.Her initial ECG (Figure 1) demonstrated sinus tachycardia with deep T wave inversions in both precordial and limb leads.Her bloods revealed high sensitivity Troponin-T of 395ng/L [normal reference range <15ng/L].Her bedside echocardiogram revealed typical pattern of "apical ballooning" with severe hypokinesis in the anterior, lateral, septal and inferior walls of the left ventricle, sparing the basal walls.Her left ventricular systolic function was moderately impaired with an ejection fraction (EF) of 40% (Figure 2).Both her clinical presentation and echocardiographic appearances were highly suggestive of "Takotsubo Cardiomyopathy".Nevertheless, she was conventionally treated for presumed "Non-ST elevation myocardial infarction (NSTEMI)" at the initial stages [1].