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Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series

Annie Y Chou1, Tara Sedlak1, Eve Aymong2

  • 1Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

The Canadian Journal of Cardiology
|July 28, 2015
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) can mimic Takotsubo cardiomyopathy (TTC), leading to misdiagnosis. Coronary angiograms require careful review to identify subtle SCAD in patients suspected of having TTC.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TTC) share clinical presentations, including myocardial infarction and reversible wall motion abnormalities.
  • Misdiagnosis between SCAD and TTC can occur, impacting appropriate patient management.

Purpose of the Study:

  • To investigate the incidence of SCAD misdiagnosis in patients initially suspected of having TTC.
  • To identify clinical characteristics differentiating SCAD from TTC.

Main Methods:

  • Retrospective review of coronary angiograms from patients diagnosed with TTC at Vancouver General Hospital.
  • Recording of clinical and investigational characteristics of patients with confirmed SCAD.

Main Results:

  • Nine women (average age 55) with nonatherosclerotic SCAD were misdiagnosed as TTC.
  • Hypertension (5 patients), stress (4 patients), and fibromuscular dysplasia (4 patients) were noted comorbidities.
  • Wall motion abnormalities in SCAD patients corresponded to the dissected artery and resolved over time.

Conclusions:

  • SCAD should be considered in the differential diagnosis for patients presenting with symptoms suggestive of TTC.
  • Thorough scrutiny of coronary angiograms is crucial for detecting subtle signs of SCAD to prevent misdiagnosis.

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