Takotsubo Cardiomyopathy with Rapid Recovery Revealing Underlying Coronary Artery Disease
Background
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a temporary cardiac condition marked by acute but reversible left ventricular dysfunction. It often results from emotional or physical stress. Although typically seen without notable coronary artery disease, its coexistence with severe coronary lesions is rare and poses diagnostic and therapeutic difficulties.
Case Presentation
A 56-year-old Asian woman with hypertension and diabetes experienced sudden chest pain after a severe emotional and physical confrontation. Upon hospital admission, her condition was stable. An electrocardiogram showed slight ST-segment elevation in the anterior leads, accompanied by a modest troponin increase.
Bedside echocardiography indicated apical akinesia, suggesting Takotsubo cardiomyopathy. Subsequent coronary angiography revealed high-risk multivessel coronary artery disease, including significant narrowing of the left main artery. Despite this, her cardiac function improved rapidly within five days, with normalization of ejection fraction and global longitudinal strain, aligning with Takotsubo cardiomyopathy recovery.
Since the patient declined coronary artery bypass surgery, a percutaneous coronary intervention was carried out successfully on the left main and left anterior descending arteries. She was discharged in stable condition under optimal medical therapy.
Key Clinical Insight
This case demonstrates how Takotsubo cardiomyopathy can coexist with significant coronary artery disease, requiring careful assessment to determine the most appropriate management strategy.
Author Summary: A case showcasing rapid functional recovery in Takotsubo cardiomyopathy that revealed silent but serious coronary artery disease, emphasizing the importance of thorough evaluation in similar cases.
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