He had a prior medical history of thoracic outlet syndrome, but no history of coronary artery disease or significant heart disease.
Picture A: X-ray of chest without evidence of acute cardiopulmonary process Picture B: Ventriculography shows abnormality of movement of middle ventricular wall. Photos: Ponce Health Sciences University, Emergency Medicine Residency.
The literature describes the case of a 59-year-old woman who came to the hospital with complaints of chest pain and nausea. There was no diaphoresis, respiratory distress, or radiation of pain.
No history of heart disease
He had a prior medical history of thoracic outlet syndrome, but no history of coronary artery disease (CAD) or significant heart disease. Despite taking medicine, the pain continued. That day, her son arrived in Puerto Rico to surprise her, which could be the cause of the incident.
On examination, the patient is noted to be uncomfortable due to pain. His respiratory examination revealed normal lung auscultation, no respiratory distress, and the ability to speak complete sentences. Regarding the cardiovascular and thoracic test, no sensitivity abnormalities were found, in addition, the heart rate and rhythm were regular.
Peripheral pulses are symmetrical and strong in the upper and lower extremities. In addition, the blood pressure was 135/78 in the left arm and 147/84 in the right arm. No edema was observed in the extremities, and capillary refill took less than 2 seconds. No sensory or motor deficits were found in the extremities.
Cardiac catheterization
As his condition improved, serial electrocardiograms were performed that showed diffuse ST segment depressions. Despite initial efforts at medication, the pain did not go away. A repeated troponin showed a value of 1957, prompting the patient to undergo cardiac catheterization.
Catheterization revealed no evidence of obstructive disease, and the cardiac ejection fraction was greater than 55%. However, ventriculography showed an abnormality in midventricular wall motion, consistent with a rare midventricular variant. Takotsubo cardiomyopathy.
However, the patient recovered without complications and was discharged to go home. The final diagnosis is Takotsubo cardiomyopathy medial variant. This case highlights the importance of performing cardiac catheterization in the presence of changes in the electrocardiogram suggesting ischemia, even if there is a suspicion of Takotsubo cardiomyopathy based on history and echocardiographic findings.
Takotsubo cardiomyopathy
the Takotsubo cardiomyopathy, also known as broken heart syndrome, a condition characterized by transient systolic dysfunction of the left ventricle. This is often known as stress-induced cardiomyopathy because it can be caused by emotional or physical stress.
Although it mimics an acute coronary syndrome (ACS) and may show electrocardiogram changes mimicking an acute ST-segment elevation myocardial infarction (STEMI), the final diagnosis is made by cardiac catheterization.
It should be seen that it is more common in women up to 90% of patients. In severe cases, it can cause severe heart failure, cardiogenic shock or arrhythmias. In addition, approximately one in eight women who experience it will have a recurring episode in the next five years. This variant of Takotsubo cardiomyopathy This is rare and represents the first documented case in Puerto Rico.
