Takotsubo cardiomyopathy in a man with no trigger and multiple cardioembolic complications-A rare constellation

Multiple recurrences of a left ventricular pseudoaneurysm: a case report

Background

Takotsubo syndrome (TTS) is being diagnosed more often with its increased recognition over the past 2 decades and with the availability of imaging such as point-of-care echocardiography and tissue characterization by cardiovascular magnetic resonance (CMR).

Case summary

A young man developed pericarditis and was treated with steroids. A few weeks later, he suffered classic TTS and then presented a week later with the rare complication of apical myocardial rupture and a left ventricular (LV) pseudoaneurysm. He subsequently sustained two recurrences, likely secondary to the poor tensile strength of the repair in the region of necrotic myocardium.

Discussion

Various features of both syndromes are discussed herein (myopericarditis and TTS) as well as their classic imaging findings with an emphasis on the echocardiographic diagnosis of an LV pseudoaneurysm and differentiating it from an aneurysm. Furthermore, we elucidate the classic imaging findings of CMR in myocarditis, myocardial infarction with non-obstructive coronary arteries, and TTS. Lastly, we discuss treatment options for LV pseudoaneurysms and strategies to prevent recurrence.

Takotsubo cardiomyopathy misdiagnosed as acute myocardial infarction under the Chest Pain Center model: A case report

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.