Abstract
Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients. Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch. Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 125-128 |
| Number of pages | 4 |
| Journal | Texas Heart Institute Journal |
| Volume | 39 |
| Issue number | 1 |
| State | Published - 2012 |
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Keywords
- Chest pain/etiology
- Coronary artery disease/complications
- Diagnosis
- Differential
- Takotsubo cardiomyopathy/diagnosis/physiopathology/therapy
- Ventricular dysfunction, Left/diagnosis/physiopathology
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Left anterior descending coronary artery stenosis : In a patient with takotsubo cardiomyopathy. / Vittala, Satya S.; Najib, Mohammad Q.; Click, Roger L.; Fortuin, F. David; Chaliki, Hari P.
In: Texas Heart Institute Journal, Vol. 39, No. 1, 2012, p. 125-128.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Left anterior descending coronary artery stenosis
T2 - In a patient with takotsubo cardiomyopathy
AU - Vittala, Satya S.
AU - Najib, Mohammad Q.
AU - Click, Roger L.
AU - Fortuin, F. David
AU - Chaliki, Hari P
PY - 2012
Y1 - 2012
N2 - Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients. Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch. Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.
AB - Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients. Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch. Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.
KW - Chest pain/etiology
KW - Coronary artery disease/complications
KW - Diagnosis
KW - Differential
KW - Takotsubo cardiomyopathy/diagnosis/physiopathology/therapy
KW - Ventricular dysfunction, Left/diagnosis/physiopathology
UR - http://www.scopus.com/inward/record.url?scp=84864088960&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864088960&partnerID=8YFLogxK
M3 - Article
C2 - 22412247
AN - SCOPUS:84864088960
VL - 39
SP - 125
EP - 128
JO - Texas Heart Institute Journal
JF - Texas Heart Institute Journal
SN - 0730-2347
IS - 1
ER -