Left anterior descending coronary artery stenosis: In a patient with takotsubo cardiomyopathy

Satya S. Vittala, Mohammad Q. Najib, Roger L. Click, F. David Fortuin, Hari P. Chaliki

Research output: Contribution to journalArticle

4 Scopus citations

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 languageEnglish (US)
Pages (from-to)125-128
Number of pages4
JournalTexas Heart Institute Journal
Volume39
Issue number1
StatePublished - Sep 27 2012

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

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