Stress kardiomyopathy triggered by unusual situation

Stress - “takotsubo” cardiomyopathy - is a reversible mimicking acute myocardial infarction. The trigger is extreme mental or physical stress. The main diagnostic examination is ventriculography with typical left ventricle apical ballooning wall motion abnormality. We present a case report of 63 years old woman, hospitalized at the Department of IV. internal Clinic Medical Faculty and University Hospital Bratislava due to angina. The main trigger was atypical stress situation - urgent need to urinate. On admission, the patients condition was dominated by the hypertension emergency, tachycardia and psychic tension. The ECG on admission revealed the sinus tachycardia and only marked ST elevation in leads I, II, V3-V6. The negative T wave in the leads I, II, V1-V6 was documented on latter ECG. Following the dynamics of troponin levels we assumed the non-STEMI, but due to psychic stress we also considered stress cardiomyopathy. Our patient underwent the coronary angiography and only marginal changes were present. The catecholamine cardiomyopathy with left ventricular apical wall motion abnormality, mild reduction of ejection fraction (48-50 %) and 1st degree of diastolic dysfunction was proved by ventriculography and echocardiography. After the 2 months follow-up, echocardiography confirmed the physiologic finding. This case report points out to the atypical urgent situation that provoked the stress cardiomyopathy.