TITLE: Takotsubo Syndrome: A Case Report
KEY WORDS: Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left; Acute Coronary Syndrome; Chest pain; Psychological Stress.
ABSTRACT
Introduction: The Takotsubo Syndrome or Cardiomyopathy (CMT) is characterized by regional and transient left ventricular systolic dysfunction. It is an important etiology in the differential diagnosis of chest pain, since it is able to mimic the clinical presentation of acute coronary syndrome (ACS), in the absence of evidence of obstructive arterial disease (CAD) at angiographic examination. It affects women in 90% of the cases, especially those in post-menopause. This condition does not have a well-established etiopathogenesis. Methodology: This is a case report that aims to bring CMT as a differential diagnosis of ACS and discuss its particularities, in order to expand knowledge aimed at improving health conditions for the population. Case Report: A.L.S, female, 55 years old, postmenopausal, with a history of hypertension and generalized anxiety disorder, admitted with typical precordialgia triggered by emotional stress. The first hypothesis raised was of ACS, corroborated by the electrocardiographic findings and the enzymatic curve of myocardial necrosis markers (MNM). Cardiac catheterization (CATH) demonstrated that coronary arteries were free from obstructive atheromatosis, and left ventriculography, presence of anterior and apical hypokinesia, imaging findings that rule out the initial diagnosis and suggest CMT. Evolved on hospitalization with hemodynamic stability, full recovery of contractile myocardial function and improvement of chest pain. Discussion: The clinical presentation of the patient at admission raised the diagnostic assumption of an acute myocardial infarction without ST segment elevation (NSTEMI). The absence of obstructive atheromatosis at CATH, however, ruled out the possibility of NSTEMI and reinforced CMT as the most likely etiology of the condition, since it is capable of mimicking ACS, but without coronary atherothrombotic obstruction. The hypothesis of CMT should be considered as a differential diagnosis of ACS, especially in postmenopausal women. The patient presented typical imaging findings on ecodopplercardiography and ventriculography, such as the presence of hypokinesia in the apical and middle segment of the left ventricle (LV) and hyperkinesia in basal segments, giving the classic aspect of apical ballooning or “octopus trap” that gives the name to the disease - from Japanese Takotsubo. Through CATH obstructive coronary disease or acute rupture of atheromatous plaque were excluded. The therapeutic strategy was basically structured on hemodynamic support and control of possible complications. As stated, the reported case has characteristics compatible with CMT, from its clinical presentation at admission to the evidence of abnormalities of the LV wall in the study with ventriculography, and absence of signs of obstructive pathology to the study of coronary angiography, which corroborates with the pattern described by the literature of this pathology. Results: This report made possible a theoretical deepening on the theme and the dissemination in the medical and academic community of the peculiarities of this syndrome. Conclusion: Based on the similarity between the clinical courses of Takotsubo Cardiomyopathy and Acute Myocardial Infarction, the relevance of CMT as a differential diagnosis of chest pain is highlighted. Therefore, it is necessary to know its epidemiological, clinical and radiological aspects.
