A 66-year-old female with Takotsubo syndrome presented with ST elevation, initially misdiagnosed as acute coronary syndrome, emphasizing the need for careful differential diagnosis.
This case report illustrates the diagnostic challenge of distinguishing Takotsubo syndrome from acute coronary syndrome and the potential for rapid, fatal clinical deterioration.
Absolute Event Rate: 0% vs 0%
Introduction. Takatsubo syndrome is not an infrequent clinical entity in which there is transient left ventricular systolic dysfunction, often induced by emotional stress, organic disease or their combination. Clinically, it is often hard to distinguish it from acute coronary syndrome and it poses a differential-diagnostic dilemma in everyday practice. The aim of our case presentation was to report a patient with Takotsubo syndrome, initially treated as an acute coronary syndrome, with a review and comment on the available literature. Case report. A 66-year-old female patient, with a past medical history of treated arterial hypertension, presented to the health service because of chest tightness that she had been experiencing for the past 48 hours. She cites the intense emotional stress that preceded the beginning of her complaints - the loss of her dog and the fear that it could hurt someone. Because of the appreciated ST segment elevation in the precordial leads, she was referred for emergency coronary angiography to the PCI center. There were no angiographically significant lesions in the epicardial coronary arteries. Echocardiography was performed, which showed a severely impaired global left ventricular systolic function with characteristic pattern of akinesia of the apical and medial and hyperkinesia of the basal segments of all the walls of the left ventricle, which, along with the anamnestic and demographic data, supported the diagnosis of the apical subtype of Takotsubo syndrome. Natriuretic peptides and especially troponin were elevated. Heart failure therapy was started with the initial hemodynamic stability of the patient. The next day, pulmonary edema refractory to treatment developed and resulted in death. Conclusion. Suspicion of Takotsubo syndrome in patients with appropriate demographic (postmenopausal women) or clinical profile (intense emotional stress or intercurrent organic disease) with echocardiographic or ventriculographic confirmation and mandatory exclusion of obstructive coronary disease by coronary angiography and risk stratification using clinical variables such as natriuretic peptides, troponin, left ventricular ejection fraction, the presence of thrombus in the left ventricle or obstruction of the left ventricular outflow tract determines the further direction and intensity of the patient's treatment.
Nikolić et al. (Mon,) reported a other. A 66-year-old female with Takotsubo syndrome presented with ST elevation, initially misdiagnosed as acute coronary syndrome, emphasizing the need for careful differential diagnosis.