Simultaneous Takotsubo syndrome and spontaneous coronary artery dissection: a case report
Carla Oliveira Ferreira1, Cátia Costa Oliveira2, Carlos Galvão Braga2
1Cardiology Resident.
Insights
This case study details a woman experiencing chest pain due to spontaneous coronary artery dissection, initially misdiagnosed as Takotsubo syndrome. Prompt diagnosis and treatment led to full recovery, highlighting this rare association.
Area of Science:
- Cardiology
- Cardiovascular Medicine
Background:
- Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are distinct cardiovascular conditions.
- Both TTS and SCAD predominantly affect women and can be triggered by emotional stress.
- The association between TTS and SCAD is often overlooked, leading to diagnostic challenges.
Abstract:
A 59-year-old woman presented to the emergency room with sudden onset of retrosternal thoracic pain following emotional stress. The electrocardiogram (ECG) revealed T-wave inversions on precordial leads. Her blood analyses demonstrated elevation of myocardial necrosis markers (peak of troponin I of 3.4 ng/ml). Transthoracic echocardiogram (TTE) findings were consistent with Takotsubo syndrome, accompanied by mild left ventricular dysfunction. The patient underwent invasive coronary angiography revealing a spontaneous coronary artery dissection in the left anterior descending artery and left main artery. A repeat TTE one week later showed complete resolution of the segmental contractility with a full recovery of left ventricular function. Cardiac magnetic resonance imaging revealed no abnormalities. The patient was discharged on dual-antiplatelet therapy. A follow-up coronary angiography performed one month later confirmed complete resolution of the dissection. Takotsubo syndrome and spontaneous coronary artery dissection predominantly affect women and share common triggers. This case highlights the often misdiagnosed association and emphasises the specific diagnosis and treatment nuances associated with it.
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