Complex case of Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an unusual form of acute cardiomyopathy triggered by intense physical or emotional positive and negative stress. It involves left ventricular apical ballooning and mimics acute myocardial infarction. We present the case of a 74 year-old woman addressed to our clinic with the hypothesis of acute coronary syndrome in the context of T wave inversions in anterior leads associated with atypical chest pain and acute pain in the left lower limb.  She reported medical history of hypertension and repeated episodes of deep vein thrombosis with therapeutic limitations to anticoagulation and antiplatelet therapy because of the side effects. Due to high suspicion of acute coronary syndrome she underwent emergency coronary angiography, which revealed no significant coronary artery lesions but cardiac catheterization showed severe anterior-apical akinesia with compensatory infero-posterior hyperkinesis. This case report represents a diagnostic and also a therapeutic challenge because of the fortuitous diagnosis in the context of acute pain in the left lower limb which may cause confusion with the diagnosis of deep vein thrombosis. The acute pain in the left lower limb may also be considered the trigger factor for the Takotsubo cardiomyopathy in our patient.