Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Figure 1 A case of midventricular takotsubo syndrome discharged under diagnosis of myocardial infarction. A typical mid-ventricular takotsubo syndrome triggered by an emotional stress in a 79-years-old man with chronic co-morbidities in the form of chronic obstructive pulmonary disease and carcinoma of urinary bladder. The case was incorrectly diagnosed as type 2 myocardial infarction according to the universal definition of myocardial infarction as seen in the discharge diagnosis. A: Electrocardiogram during admission; B: Left coronary artery shows moderate stenosis in the left anterior descending artery, which cannot explain the circumferential mid-ventricular left ventricular wall motion abnormality; C: Normal right coronary artery (RCA); D and E: Contrast left ventriculography during diastole and systole showing mid-ventricular ballooning pattern. There was modest elevation of troponin T (595 ng/L); F and G: Echocardiography during diastole and systole confirming the left ventriculography finding of mid-ventricular ballooning.