Marco Lombardi1, Rocco Vergallo1, Giovanna Liuzzo1, Filippo Crea1. 1. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8-00168 Rome, Italy.
Abstract
BACKGROUND: Takotsubo syndrome (TTS) is a disease characterized by an acute and reversible myocardial injury typically precipitated by stressful and/or emotional triggers. Despite extensive research, its pathogenesis remains incompletely understood. Spasm of epicardial coronary arteries has been proposed as a potential pathogenic factor in TTS. CASE SUMMARY: Herein, we report the case of a 68-year-old female admitted to the emergency department after developing chest pain in concomitance with an intense emotional stress. A diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) was made. Coronary angiography disclosed normal coronary arteries, and left ventriculography showed an inferior focal akinesia with basal and apical hyperkinesis, so that a diagnosis of 'focal TTS' was made. Two months later, the patient was re-admitted with NSTEMI, and repeat coronary angiography showed an irregular subocclusive stenosis of a well-developed first obtuse marginal branch. After intracoronary nitroglycerine infusion, a complete recover of the vessel patency was noted, and a diagnosis of epicardial spasm was made. Intracoronary optical coherence tomography was performed to assess a residual 'hazy' region, which confirmed a normal vessel morphology and a residual focal area of spasm without signs of instability. DISCUSSION: Whether TTS and coronary artery spasm are two expressions of the same disease, or rather two separate entities with overlapping mechanisms remains unknown, and further research is warranted to solve this issue. Meanwhile, the opportunity of performing provocative tests for coronary spasm in patients with suspected TTS might be considered to gain more insights into this hypothesis.
BACKGROUND: Takotsubo syndrome (TTS) is a disease characterized by an acute and reversible myocardial injury typically precipitated by stressful and/or emotional triggers. Despite extensive research, its pathogenesis remains incompletely understood. Spasm of epicardial coronary arteries has been proposed as a potential pathogenic factor in TTS. CASE SUMMARY: Herein, we report the case of a 68-year-old female admitted to the emergency department after developing chest pain in concomitance with an intense emotional stress. A diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) was made. Coronary angiography disclosed normal coronary arteries, and left ventriculography showed an inferior focal akinesia with basal and apical hyperkinesis, so that a diagnosis of 'focal TTS' was made. Two months later, the patient was re-admitted with NSTEMI, and repeat coronary angiography showed an irregular subocclusive stenosis of a well-developed first obtuse marginal branch. After intracoronary nitroglycerine infusion, a complete recover of the vessel patency was noted, and a diagnosis of epicardial spasm was made. Intracoronary optical coherence tomography was performed to assess a residual 'hazy' region, which confirmed a normal vessel morphology and a residual focal area of spasm without signs of instability. DISCUSSION: Whether TTS and coronary artery spasm are two expressions of the same disease, or rather two separate entities with overlapping mechanisms remains unknown, and further research is warranted to solve this issue. Meanwhile, the opportunity of performing provocative tests for coronary spasm in patients with suspected TTS might be considered to gain more insights into this hypothesis.
Authors: K Tsuchihashi; K Ueshima; T Uchida; N Oh-mura; K Kimura; M Owa; M Yoshiyama; S Miyazaki; K Haze; H Ogawa; T Honda; M Hase; R Kai; I Morii Journal: J Am Coll Cardiol Date: 2001-07 Impact factor: 24.094
Authors: Christian Templin; Jelena R Ghadri; Johanna Diekmann; L Christian Napp; Dana R Bataiosu; Milosz Jaguszewski; Victoria L Cammann; Annahita Sarcon; Verena Geyer; Catharina A Neumann; Burkhardt Seifert; Jens Hellermann; Moritz Schwyzer; Katharina Eisenhardt; Josef Jenewein; Jennifer Franke; Hugo A Katus; Christof Burgdorf; Heribert Schunkert; Christian Moeller; Holger Thiele; Johann Bauersachs; Carsten Tschöpe; Heinz-Peter Schultheiss; Charles A Laney; Lawrence Rajan; Guido Michels; Roman Pfister; Christian Ukena; Michael Böhm; Raimund Erbel; Alessandro Cuneo; Karl-Heinz Kuck; Claudius Jacobshagen; Gerd Hasenfuss; Mahir Karakas; Wolfgang Koenig; Wolfgang Rottbauer; Samir M Said; Ruediger C Braun-Dullaeus; Florim Cuculi; Adrian Banning; Thomas A Fischer; Tuija Vasankari; K E Juhani Airaksinen; Marcin Fijalkowski; Andrzej Rynkiewicz; Maciej Pawlak; Grzegorz Opolski; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Filippo Crea; Wolfgang Dichtl; Wolfgang M Franz; Klaus Empen; Stephan B Felix; Clément Delmas; Olivier Lairez; Paul Erne; Jeroen J Bax; Ian Ford; Frank Ruschitzka; Abhiram Prasad; Thomas F Lüscher Journal: N Engl J Med Date: 2015-09-03 Impact factor: 91.245