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Broken heart in elderly patients: two clinical observations
Alois Saller1, Fabio De Stefano, Emanuele Allemand
1Department of Medicine, University of Padova, Padova, Italy. alois.saller@unipd.it
Aging Clinical and Experimental Research
|May 31, 2012
Summary
Tako-tsubo cardiomyopathy, a reversible heart condition, mimics heart attacks but lacks coronary artery blockages. This case study highlights its diagnosis in elderly women, showing full recovery.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Tako-tsubo cardiomyopathy (TC) is a reversible condition often triggered by stress, clinically resembling acute myocardial infarction.
- It is characterized by left ventricular apical ballooning due to hypokinesis/akinesis in mid-apical segments without coronary artery disease.
Observation:
- This report details two elderly women (78 and 82 years) presenting with chest pain, ECG changes, and elevated troponin I.
- Echocardiography revealed apical akinesia with basal hyperkinesis and reduced ejection fraction, consistent with TC.
- Coronary angiography showed minimal irregularities, ruling out obstructive coronary lesions, plaque rupture, or thrombus.
Findings:
- The wall motion abnormalities extended beyond single coronary artery territories, supporting a diagnosis of apical ballooning syndrome (ABS).
- ABS was diagnosed by exclusion, with findings consistent with the condition.
- Both patients recovered fully within four weeks, with normalized ejection fraction on repeat echocardiography.
Implications:
- Tako-tsubo cardiomyopathy incidence may be underestimated in elderly patients, particularly when coronary angiography is not routinely performed.
- This condition is a diagnosis of exclusion, emphasizing the importance of comprehensive diagnostic evaluation.
- Prompt diagnosis and management lead to complete recovery, highlighting the reversible nature of TC.
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