A 65-year-old woman was transferred to our Cardiology Department due to a syncope
in the sitting position, without prodromes and with mandibular trauma, after a 30-minute
walk. Apart from dyslipidemia, she had no other cardiovascular risk factors, being
physically active. She was under emotional stress due to her father's recent death.
Physical examination was unremarkable except for a small bruise on the jaw. First
electrocardiogram showed sinus tachycardia, 120/min, 1 mm ST-elevation in aVL and
a less than 1 mm ST-depression in the inferior leads. Troponin T was elevated (maximum
value of 519 pg/ml; reference value of <14 pg/ml). Transthoracic echocardiogram showed
a mild depression on the left ventricular (LV) systolic function (LV ejection fraction
of 45%) with severe hypokinesia of all midventricular segments. Coronariography revealed
no significant coronary lesions and ventriculography unveiled an akinesia of all LV
median segments, with preserved contractility of basal and apical segments (Fig.), compatible with the diagnosis of the midventricular variant of Takotsubo Syndrome
(TTS). She initiated medical therapy and had no complications during hospitalization.
She was discharged medicated with bisoprolol 2.5 mg, ramipril 2.5 mg and atorvastatin
40 mg.
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References
- Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?.Rev Port Cardiol. 2019; 38: 261-266https://doi.org/10.1016/j.repc.2018.07.008
- Current knowledge and future challenges in takotsubo syndrome: part 1—pathophysiology and diagnosis.J Clin Med. 2021; 10: 1-23https://doi.org/10.3390/jcm10030479
- International Expert Consensus Document on Takotsubo Syndrome (Part II): diagnostic Workup, Outcome, and Management.Eur Heart J. 2018; 39: 2047-2062https://doi.org/10.1093/eurheartj/ehy077
Article info
Publication history
Published online: October 22, 2022
Accepted:
October 17,
2022
Received:
January 6,
2022
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
