Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2616-2621
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2616
Takotsubo cardiomyopathy misdiagnosed as acute myocardial infarction under the Chest Pain Center model: A case report
Li-Ping Meng, Peng Zhang
Li-Ping Meng, Peng Zhang, Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
Author contributions: Meng LP and Zhang P contributed equally to this work; Meng LP and Zhang P performed the surgery; Meng LP and Zhang P wrote the paper.
Supported by the National Natural Science Foundation of China, No. 82000252.
Informed consent statement: The patient has provided informed consent for the publication of the case.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised accordingly.
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Corresponding author: Peng Zhang, MD, Chief Physician, Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), No. 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China. ymgd_995@163.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: November 11, 2021
Revised: December 15, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: March 16, 2022
Processing time: 150 Days and 15.6 Hours
Abstract
BACKGROUND

With the spread and establishment of the Chest Pain Center in China, adhering to the idea that “time is myocardial cell and time is life”, many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction (AMI) who meet emergency percutaneous coronary intervention (PCI) guidelines are sent directly to the DSA room by the prehospital emergency doctor, saving the time spent on queuing, registration, payment, re-examination by the emergency doctor, and obtaining consent for surgery after arriving at the hospital. Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.

CASE SUMMARY

A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead, without being transferred to the emergency department according to the Chest Pain Center model. Loading doses of aspirin, clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance. On first look, the patient looked nervous in the DSA room. Coronary angiography showed no obvious stenosis. Left ventricular angiography showed that the contraction of the left ventricular apex was weakened, and the systolic period was ballooning out, showing a typical “octopus trap” change. The patient was diagnosed with Takotsubo cardiomyopathy. Five days later, the patient had no symptoms of thoracalgia, and the serological indicators returned to normal. She was discharged with a prescription of medication.

CONCLUSION

Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation, despite the urgency of time, Takotsubo cardiomyopathy must be promptly differentiated from AMI for its appropriate management.

Keywords: Chest pain center; Takotsubo cardiomyopathy; Acute myocardial infarction; Percutaneous coronary intervention; Case report

Core tip: Under the Chest Pain Center model for the treatment of patients with chest pain with ST segment elevation, despite the urgency of time, Takotsubo cardiomyopathy must be promptly differentiated from myocardial infarction for its appropriate management.