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ABSTRACT

Takotsubo syndrome (TTS) is defined as a transient left ventricular apical ballooning without coronary occlusion that typically occurs in older women after emotional or physical stress. It has a transient nature and is referred to as acute myocarditis with coronary vasculitis. The pathogenesis of TTS is multifactorial, so several possible factors such as catecholamine cardiotoxicity, metabolic disturbance, coronary microvascular impairment, and multi-vessel epicardial coronary artery spasm may be involved. The revised Mayo Clinic diagnostic criteria of TTS are transient dyskinesis of the left ventricular midsegments, regional wall motion abnormalities beyond a single epicardial vascular distribution, absence of obstructive coronary artery disease or acute plaque rupture. The presentation of TTS is usually like acute coronary syndrome, so differential diagnosis is mandatory for treatment. Diagnostic noninvasive tools are imaging as an echocardiogram, with global longitudinal strain (GLS) when available, angio CT and cardiac MRI, laboratory tests for catecholamine, troponin T, creatine kinase MB, and B-type natriuretic peptide. The prognosis is generally better than acute coronary syndrome. We observed an 87-year-old woman, who presented with hyperpyrexia, abdominal pain, and rectorrhagia, without thoracic pain and dyspnea. High-sensitivity troponin levels, ECG, and left ventricular systolic dysfunction by echo suggested a diagnosis of TTS, the patient did not undergo coronary angiography because of a septic state and poor general conditions. On discharge, she presented normal left ventricular ejection fraction with mild hypokinesia of the apical segment.

Keywords: Takotsubo syndrome, Stress-induced syndrome, Catecholamine cardiotoxicity, Apical ballooning syndrome, Diagnostic criteria