Takotsubo Cardiomyopathy Presenting as Acute Myocardial Infarction

Background: Takotsubo cardiomyopathy, named for its distinctive ballooning of the left ventricular apex, is a stress induced heart condition characterized by transient systolic and diastolic left ventricular dysfunction with a variety of regional wall-motion abnormalities. In some cases, it can be misdiagnosed as an acute myocardial infarction.

Case: In an rare case presentation, a 71 year old female with a history of hypertension, liver dysfunction, and thrombocytopenia presented to the emergency room for weakness, fatigue, fever, and watery diarrhea. She had an episode of severe chest pain that resolved on its own. Her preliminary studies showed elevated troponin. The next day, she was taken to the cath lab for invasive studying. Following the cath, she developed hypotension and narrowing pulse pressure with jugular venous distension (JVD). A transthoracic echocardiogram (TTE) showed pericardial effusion with tamponade physiology. The patient also exhibited severe ventricular systolic dysfunction, as well as a large apical aneurysm of the left ventricle. She was diagnosed with Takotsubo cardiomyopathy, and a cardiothoracic surgeon was consulted for an emergent pericardial window for cardiac tamponade. The next day, she underwent an emergency sternotomy for evacuation of the hemopericardium.

Conclusions: Takotsubo cardiomyopathy (TCM), like an acute myocardial infarction (AMI), is an acute cardiac syndrome that can be distinguished from an AMI from absence of a coronary arterial obstruction. However, TCM and AMI may have certain correlations that have not yet been discovered. On the other hand, the fact that TCM can present as an AMI along with evidence showing that these can occur simultaneously can complicate the workup of a patient. If a patient has TCM, undergoing an invasive procedure like cardiac catheterization can not only be an unnecessary expense, but also put a patient at risk for complications.