Serial strain imaging in takotsubo syndrome with concomitant coronary artery disease

Area of Science:

• Cardiology
• Neurology
• Infectious Diseases

Background:

• Takotsubo syndrome (TTS) is a reversible heart condition often triggered by emotional or physical stress.
• Coronary artery disease (CAD) can present with similar symptoms, complicating diagnosis.
• Herpes encephalitis is a severe brain infection requiring prompt recognition and treatment.

Observation:

• A patient presented with symptoms suggestive of acute coronary syndrome (ACS).
• The patient had a history of significant triple vessel coronary artery disease (CAD).
• The patient was diagnosed with herpes encephalitis concurrently.

Findings:

• Electrocardiogram (ECG) showed typical TTS abnormalities.
• Cardiac enzymes were moderately elevated, with disproportionately high brain natriuretic peptide (BNP).
• Echocardiography and left ventricular angiography revealed characteristic wall motion abnormalities consistent with TTS, not ACS.
• Serial echocardiography demonstrated normalization of wall motion, ejection fraction, and longitudinal strain, confirming TTS.

Implications:

• This case underscores the importance of considering TTS in patients with neurological conditions and underlying CAD.
• Differentiating TTS from ACS is crucial for appropriate management, especially in complex cases.
• Herpes encephalitis can act as a significant stressor precipitating TTS, even in the presence of severe CAD.