[Repeated changes of electrocardiogram caused by Takotsubo-type cardiomyopathy: a case with hypertrophic...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Electrophysiology

Background:

• A 67-year-old woman with a history of hypertrophic nonobstructive cardiomyopathy presented with recurrent electrocardiogram (ECG) abnormalities.
• Initial ECG showed T-wave abnormalities, improving at consultation, with echocardiography revealing apical hypertrophy.

Observation:

• The patient experienced chest discomfort with significant ECG changes: negative T-waves in multiple leads and QT interval prolongation.
• Left ventriculography confirmed apical hypertrophy without wall motion abnormalities; coronary angiography ruled out significant stenosis.
• I-123 MIBG scintigraphy indicated marked perfusion defects at the left ventricular apex.

Findings:

• ECG findings demonstrated dynamic changes, including T-wave inversion and QT interval prolongation, suggestive of cardiac stress.
• Diagnostic imaging revealed left ventricular apical hypertrophy and myocardial perfusion defects, but no obstructive coronary artery disease.
• Resolution of ECG abnormalities, including QT interval shortening and decreased T-wave negativity, was observed over five months.

Implications:

• The case highlights the potential for Takotsubo-type cardiomyopathy to mimic or coexist with hypertrophic cardiomyopathy.
• Recognizing dynamic ECG changes and perfusion defects is crucial for diagnosing Takotsubo cardiomyopathy in patients with underlying cardiac conditions.
• This presentation underscores the importance of comprehensive diagnostic evaluation for complex cardiac presentations.