Takotsubo Syndrome and Spontaneous Coronary Artery Dissection

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Myocardial infarction (MI) and Takotsubo syndrome (TTS) are uncommon causes of chest pain in young women.
• Chest pain in this demographic necessitates a thorough diagnostic evaluation.

Observation:

• A 36-year-old woman presented with acute chest pain following an extreme cough.
• Initial ECG showed inferior ST-segment elevations; echocardiography revealed apical ballooning consistent with TTS.
• Invasive angiography was initially normal, but cardiac MRI confirmed coexisting inferolateral MI and TTS.

Findings:

• Cardiac MRI confirmed an inferolateral transmural MI and TTS.
• Re-evaluation of angiography suggested spontaneous coronary artery dissection (SCAD) of the second obtuse marginal branch.
• A patent foramen ovale was also diagnosed.

Implications:

• This case illustrates a rare combination of SCAD-induced ST-elevation MI, subsequent TTS, and a patent foramen ovale.
• It underscores the importance of advanced imaging like MRI in diagnosing complex cardiovascular conditions.
• The case highlights the diagnostic challenges and potential etiologies of chest pain in young women.