Document Type : Case Report
Authors
1 Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Practitioner, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medicine Sciences, Isfahan, Iran
Abstract
BACKGROUND: Takotsubo syndrome (TS) is a reversible left ventricular (LV) systolic dysfunction occurred mostly in post-menopausal women after an emotional or physical stress. The exact mechanism has yet to be found. In clinical settings, TS should be differentiated from myocardial infarction (MI) due to totally different management protocols. Several diagnostic criteria are available, but mayo clinic criteria is the most widely used. Prognosis of TS is favorable and the recurrence and mortality rates are low. Treatment is mostly supportive and after a few weeks, most of patients’ electrocardiography (ECG) and echocardiographic findings will be normalized, though to its benign course, TS can cause some complications. Intra-myocardial dissection and LV apical aneurysm, as a complication of TS has never been reported yet and was just announced in rare cases of MI.CASE REPORT: Our patient was a 32-year-old aphasic woman referring with palpitation and chest discomfort. Further examinations after exclusion of MI revealed TS leading to LV apical aneurysm and intra-myocardial dissection.CONCLUSION: Intra-myocardial dissection should be considered as one of the rarest TS complications. Several studies are necessary for defining the exact pathophysiological mechanisms.
Keywords
- Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: A new form of acute, reversible heart failure. Circulation 2008; 118(25): 2754-62.
- Guttormsen B, Nee L, Makielski JC, Keevil JG. Transient left ventricular apical ballooning: A review of the literature. WMJ 2006; 105(3): 49-54.
- Komamura K, Fukui M, Iwasaku T, Hirotani S, Masuyama T. Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. World J Cardiol 2014; 6(7): 602-9.
- Roshanzamir S, Showkathali R. Takotsubo cardiomyopathy a short review. Curr Cardiol Rev 2013; 9(3): 191-6.
- Sealove BA, Tiyyagura S, Fuster V. Takotsubo cardiomyopathy. J Gen Intern Med 2008; 23(11): 1904-8.
- Kurisu S, Kihara Y. Clinical management of Takotsubo cardiomyopathy. Circ J 2014; 78(7): 1559-66.
- Castillo Rivera AM, Ruiz-Bailen M, Rucabado Aguilar L. Takotsubo cardiomyopathy-a clinical review. Med Sci Monit 2011; 17(6): RA135-RA147.
- Liu CC, Wang LS, Su ZP, Zhao Y, Gu CX. Intramyocardial dissection with concomitant left ventricular aneurysm as a rare complication of myocardial infarction: A case report. J Geriatr Cardiol 2016; 13(7): 632-5.
- Xie M, Zhou H, Cheng TO, Wang J, Wang X, Lu Q, et al. Left ventricular apical aneurysm associated with normal coronary arteries following cardiac surgery: echocardiographic features and differential diagnosis. Int J Cardiol 2013; 168(4): 3665-70.
- Hassan S, Themudo R, Maret E. Spontaneous coronary artery dissection and Takotsubo syndrome: The chicken or the egg causality dilemma. Catheter Cardiovasc Interv 2017; 89(7): 1215-8.
- Apple FS, Quist HE, Doyle PJ, Otto AP, Murakami MM. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology consensus recommendations. Clin Chem 2003; 49(8): 1331-6.
- Sharkey SW, Maron BJ. Epidemiology and clinical profile of Takotsubo cardiomyopathy. Circ J 2014; 78(9): 2119-28.
- Segovia Cubero J, Peraira Moral R. Transient apical ballooning syndrome: A transition towards adulthood. Rev Esp Cardiol 2004; 57(3): 194-7.
- Murase K, Takagi K. Takotsubo cardiomyopathy in a snake bite victim: A case report. Pan Afr Med J 2012; 13: 51.
- Watanabe H, Kodama M, Okura Y, Aizawa Y, Tanabe N, Chinushi M, et al. Impact of earthquakes on Takotsubo cardiomyopathy. JAMA 2005; 294(3): 305-7.
- Ogura R, Hiasa Y, Takahashi T, Yamaguchi K, Fujiwara K, Ohara Y, et al. Specific findings of the standard 12-lead ECG in patients with 'Takotsubo' cardiomyopathy: Comparison with the findings of acute anterior myocardial infarction. Circ J 2003; 67(8): 687-90.
- Hayashi H, Kimura M, Kato T, Nakasone K, Seko Y, Sekihara T, et al. Reversible left ventricular wall thickening with Takotsubo syndrome sequentially detected by cardiac magnetic resonance imaging. Intern Med 2018; 57(4): 517-22.
- Bakhit A, Bin Abdulhak A. Spontaneous coronary dissection misdiagnosed as Takotsubo's Cardiomyopathy. Int J Cardiol 2016; 225: 384-6.
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