Published online Oct 26, 2018. doi: 10.4330/wjc.v10.i10.187
Peer-review started: June 5, 2018
First decision: June 14, 2018
Revised: July 25, 2018
Accepted: July 22, 2018
Article in press: August 31, 2018
Published online: October 26, 2018
Patients presenting as acute coronary syndrome with left ventricular (LV) dysfunction, shock or LV outflow tract obstruction, and in whom no stenosis were found in angiography and full recovery of LV abnormality was achieved.
Acute Coronary Syndrome, cardiogenic shock.
Acute coronary syndrome due to plaque rupture, spontaneous coronary artery dissection.
Eleveted highsensitive troponin, electrocardiogram with different abnormalities such as ST depression and elevation, as well as ventricular arrhythmias.
Coronary angiography with no coronary arteries stenosis. LV dysfunction with distinctive wall motion abnormalities not correlated to specific arterial segments. LV function recovery in follow-up echocardiogram.
Beta blockers, volume replacement.
Several reports of atypical cases with wall motion abnormalities different from apical ballooning. Retrospective study, InterTAK Registry, shows incidence about 10% to 18% of atypical cases.
Takotsubo syndrome (TS) is a cardiomyopathy that simulate acute coronary syndrome, but no coronary abnormalities are present in angiography. Wall motion abnormality typically presents as apical ballooning, however, in some cases (as presented in this report) different LV segments might be affected.
Myocardial compromise in TS is not limited to the classical apical involvement and clinical presentations can range from life-threatening hemodynamic compromise to low-risk chest pain. A normal coronary angiogram and discordant LV involvement are key diagnostic features. Prompt recognition of complications and subsequent treatment allow for a favourable prognosis.