Coronary Artery Anomaly in Takotsubo Cardiomyopathy: Cause or Innocent Bystander?

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Medical Case Reports

Background:

• Coronary artery anomalies are known triggers for vasospasm and endothelial dysfunction, potentially leading to takotsubo cardiomyopathy.
• Takotsubo cardiomyopathy typically affects apical myocardial regions, not aligning with specific coronary artery territories.

Observation:

• A 74-year-old woman presented with acute respiratory failure and suspected myocardial infarction.
• The patient had a left coronary artery anomaly, dominant right coronary artery supply, takotsubo cardiomyopathy, and reduced left ventricular ejection fraction without atherosclerotic disease.

Findings:

• The anomalous left coronary artery, with dominant right coronary supply, did not appear to cause the observed apical wall-motion abnormalities.
• The patient's ejection fraction normalized after six weeks of medical treatment, and she remained asymptomatic one year later.

Implications:

• This case suggests that coronary artery anomalies may coexist with takotsubo cardiomyopathy without being the primary cause.
• It underscores the importance of considering other etiologies for takotsubo cardiomyopathy, even in the presence of coronary anomalies.
• This is the first reported instance of coexisting takotsubo cardiomyopathy and anomalous coronary artery presenting with acute dyspnea.