Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI

Takotsubo syndrome can present with ST-segment elevation, mimicking acute coronary syndrome. Dynamic left ventricular outflow tract (LVOT) obstruction often is a hemodynamic collapse in these patients.

A 64-year-old woman presented with epigastric discomfort and nausea. Initial electrocardiography showed hyperacute T waves in V₃-V₆, followed by acute inferior ST-segment elevation and reciprocal changes. Coronary angiography revealed no obstructive disease; however, there was global hypokinesia with basal hyperkinesis in left ventriculography. She developed cardiogenic shock requiring vasopressors, and decision was made to place a balloon pump for hemodynamic support. Echocardiography demonstrated systolic anterior motion of the mitral valve and dynamic LVOT obstruction (peak gradient 48 mm Hg). Alpha-1 agonist agents led to clinical improvement and stable discharge.

In Takotsubo syndrome, identifying LVOT obstruction, avoiding afterload reducers, and optimizing preload are key.

In electrocardiogram-based ST-segment elevation myocardial infarction, Takotsubo syndrome must be considered as a differential.