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Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block

Jhiamluka Solano1, Ali Hussain2, Adnan Ahmed2

  • 1Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK, ox.ac.uk.

Case Reports in Cardiology
|March 2, 2026
PubMed
Summary
This summary is machine-generated.

Takotsubo syndrome (TTS), or stress-induced cardiomyopathy, mimics heart attacks but involves temporary heart muscle dysfunction. This case highlights a postmenopausal woman diagnosed with TTS and treated with a cardiac resynchronisation therapy pacemaker.

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Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Internal Medicine

Background:

  • Takotsubo syndrome (TTS), or stress-induced cardiomyopathy, is an acute myocardial ischemic syndrome.
  • It primarily involves transient microvascular dysfunction, not epicardial coronary occlusion, leading to temporary left ventricular dysfunction.
  • Patients are predominantly postmenopausal women and symptoms can mimic acute coronary syndromes like STEMI and NSTEMI.

Purpose of the Study:

  • To present a case of a postmenopausal woman initially presumed to have STEMI.
  • To illustrate the diagnosis of takotsubo cardiomyopathy in this patient.
  • To describe the management of persistent high-grade AV block and poor ejection fraction with a cardiac resynchronisation therapy pacemaker.

Main Methods:

  • Clinical presentation review of a postmenopausal female patient.
  • Diagnostic workup for presumed ST-elevation myocardial infarction (STEMI).
  • Echocardiography and coronary angiography findings to differentiate TTS from obstructive coronary artery disease (CAD).

Main Results:

  • The patient presented with symptoms mimicking STEMI but was diagnosed with takotsubo cardiomyopathy.
  • She experienced persistent high-grade AV block and reduced ejection fraction.
  • A cardiac resynchronisation therapy pacemaker (CRT-P) was implanted for management.

Conclusions:

  • Takotsubo cardiomyopathy can present similarly to STEMI, necessitating careful differential diagnosis.
  • Persistent high-grade AV block and reduced ejection fraction are potential complications of TTS.
  • Cardiac resynchronisation therapy may be a viable treatment option for selected TTS patients with conduction abnormalities and systolic dysfunction.