Takotsubo cardiomyopathy with secondary coronary embolus

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Takotsubo syndrome (TS), also known as stress-induced cardiomyopathy, is characterized by transient left ventricular dysfunction.
• While typically presenting with apical ballooning, TS can have varied clinical manifestations and complications.

Observation:

• A 65-year-old patient presented with chest pain and ST elevation, initially managed as acute coronary syndrome.
• Coronary angiography revealed mild disease in the LAD, but an occluded distal right coronary artery branch with no flow.
• Left ventriculography showed apical ballooning and akinesis, characteristic of Takotsubo syndrome.

Findings:

• The patient's presentation and angiography findings suggested a coronary embolus secondary to Takotsubo syndrome.
• Serial cardiac biomarker monitoring showed a characteristic rise and fall pattern.
• This represents a potentially novel complication of Takotsubo syndrome, with no prior documented cases of coronary artery emboli in the literature.

Implications:

• This case highlights the importance of considering coronary embolism as a potential complication in Takotsubo syndrome.
• Further research may be warranted to understand the incidence and mechanisms of coronary thromboembolism in TS.
• Recognition of this rare complication can aid in accurate diagnosis and management of patients presenting with stress-induced cardiomyopathy.