PP 30 BROKEN HEART SYNDROME OR MYOCARDIAL INFARCT?

Abstract

INTRODUCTION

Takotsubo cardiomyopathy (TCM) may mimic acute myocardial infarct by virtue of ECG changes and raised cardiac enzyme but with negative cardiac angiogram finding as well as left ventricular apical ballooning on echocardiogram. I am presenting a case of lady presented with what appears to be an entity of cardiac failure known as “broken heart syndrome”.

CASE HISTORY

A 25 year old Myanmarese lady presented initially to our ED and treated as hyperventilation syndrome following an emotionally stressful event, and ECG at that time was sinus rhythm. On her second visit to our ED she was complaining of chest discomfort and shortness of breath. During her second visit her ECG changed from initial RBBB to ST elevation in leads I, AvL, V2 to V5 few hours later. Trop T was positive. Her echo initially shows showed right ventricular and atrial dilation but later developed akinetik mid and apical segment with normal right ventricular function and ejection fraction of 15%. In the intervening period she developed recurrent paroxysmal ventricular tachycardia with shock. PCI reveals pristine coronary vessels. She was ventilated in the coronary unit and died 24 hours later. All her septic work up was negative. Postmortem finding revealed infarcted left ventricular wall. She was treated as cardiogenic shock secondary to acute myocardial infarct. 

DISCUSSION

While the preceding history is not clear it is likely that the hyperventilation syndrome was due to acute emotional stress which later leads her to develop TCM with cardiogenic shock and eventual death. Whether the changes in echo finding first done in ED and later by cardiologist as well serial changes in ECG suggest different phase myocardium in TCM need to be studied further. It is opinion of author in view of patent coronary vessels this could be Takotsubo cardiomyopathy.