Takotsubo Syndrome Mimicking Acute Myocardial Infarction: A Case Report

Takotsubo syndrome is an acute, stress-related cardiomyopathy characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Although often clinically indistinguishable from acute coronary syndrome, Takotsubo syndrome represents a distinct form of myocardial injury within the Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) spectrum. Prompt recognition is essential, as early complications may include hemodynamic instability and clinically significant arrhythmias. We present the case of a 77-year-old woman with type 2 diabetes mellitus, systemic arterial hypertension, and a prior ischemic stroke who was admitted with intense retrosternal chest pain of a six-hour duration. Laboratory testing demonstrated elevated high-sensitivity cardiac troponin and markedly increased pro-B-type natriuretic peptide levels. Electrocardiography revealed ischemic repolarization abnormalities. Transthoracic echocardiography identified segmental systolic dysfunction involving the mid-to-apical segments with preserved basal contractility. Invasive coronary angiography excluded significant epicardial coronary stenosis, while left ventriculography demonstrated apical ballooning with basal hypercontractility, confirming the diagnosis of Takotsubo syndrome. This case highlights the importance of integrating clinical findings, biomarker profiles, and multimodality imaging in elderly women presenting with suspected acute coronary syndrome and non-obstructive coronary arteries.