Fuensalida A, Cortés M, Gabrielli L, Méndez M, Martínez A, Martínez G. Takotsubo syndrome - different presentations for a single disease: A case report and review of literature. World J Cardiol 2018; 10(10): 187-190 [PMID: 30386495 DOI: 10.4330/wjc.v10.i10.187]
Corresponding Author of This Article
Gonzalo Martínez, MD, MPhil, Assistant Professor, Division of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd floor, Santiago 833024, Metropolitana, Chile. gmartinezr@med.puc.cl
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Oct 26, 2018; 10(10): 187-190 Published online Oct 26, 2018. doi: 10.4330/wjc.v10.i10.187
Takotsubo syndrome - different presentations for a single disease: A case report and review of literature
Alberto Fuensalida, Maurice Cortés, Luigi Gabrielli, Manuel Méndez, Alejandro Martínez, Gonzalo Martínez
Alberto Fuensalida, Maurice Cortés, Luigi Gabrielli, Manuel Méndez, Alejandro Martínez, Gonzalo Martínez, Division of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago 833024, Metropolitana, Chile
Author contributions: Fuensalida A and Martinez G designed the report; Fuensalida A and Cortes M collected the clinical data; Gabrielli L performed the echocardiographies; Martinez A, Mendez M and G Martinez reviewed the coronary angiographies; Fuensalida A, Cortes M and Martinez G wrote the paper; Gabrielli L, Martinez A and Mendez M revised and commented the final manuscript.
Supported by a CONICYT research Grant (FONDECYT Iniciació n 11170205) for Dr Gonzalo Martí nez
Informed consent statement: All patients agreed to treatment and data collection by written consent at our institution.
Conflict-of-interest statement: The authors do not have any conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gonzalo Martínez, MD, MPhil, Assistant Professor, Division of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd floor, Santiago 833024, Metropolitana, Chile. gmartinezr@med.puc.cl
Telephone: +56-223-543114
Received: June 5, 2018 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 Processing time: 143 Days and 16.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics
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.
Clinical diagnosis
Acute Coronary Syndrome, cardiogenic shock.
Differential diagnosis
Acute coronary syndrome due to plaque rupture, spontaneous coronary artery dissection.
Laboratory diagnosis
Eleveted highsensitive troponin, electrocardiogram with different abnormalities such as ST depression and elevation, as well as ventricular arrhythmias.
Imaging diagnosis
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.
Treatment
Beta blockers, volume replacement.
Related reports
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.
Term explanation
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.
Experiences and lessons
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.
