International Journal of Cardiology 187 (2015) 152–153
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Takotsubo cardiomyopathy and co-existing coronary artery disease Stefan Peters ⁎ St. Elisabeth Hospital gGmbH, Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 5 February 2015 Accepted 17 March 2015 Available online 18 March 2015 Keywords: Takotsubo cardiomyopathy Coronary artery disease Apical ballooning
A 75-year old female patient was admitted to the hospital because of chest pain and palpitations.
In the ECG of the patient ST-segment elevation could be excluded. It revealed negative T-waves in lead I, aVL and V4 up to V6. Isolated troponin rise was the laboratory finding. A large apical ballooning was the dominant finding at echocardiography. Angiographically the mid-sized first diagonal branch had a 99% ostial obstruction (Fig. 1), whereas the large left anterior descending artery had several insignificant lesions. The dominant circumflex artery had a 50% obstruction in the periphery of the vessel (Fig. 2). After therapeutic approach with aspirin and clopigodrel the patient no longer had symptoms and the coronary vessels were left without intervention. In conclusion, the diagnosis of takotsubo cardiomyopathy and coronary two-vessel disease not supplying the dysfunctional myocardium was made. According to an article of Parodi et al. published in 2013 [1] 9.6% of patients have either takotsubo cardiomyopathy and additional coronary
Fig. 1. Mid-sized diagonal branch with subtotal lesion.
⁎ St. Elisabeth Hospital gGmbH, Liebenhaller Str. 20, 38259 Salzgitter, Germany. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.03.186 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Fig. 2. Circumflex artery with 50% lesion in the periphery of the vessel.
S. Peters / International Journal of Cardiology 187 (2015) 152–153
artery disease with coronary stenoses not supplying the dysfunctional myocardium. In 90.4% of takotsubo cardiomyopathy patients have irrelevant CAD or angiographically normal coronary arteries. This case report is another example that takotsubo cardiomyopathy and significant coronary artery disease can co-exist in single cases. Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
153
References [1] G. Parodi, R. Citro, B. Bellandi, S. Del Pace, F. Rigo, M. Marrani, et al., Tako-Tsubo cardiomyopathy and coronary artery disease: a pssible association, Coron. Artery Dis. 24 (2013) 527–533.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Takotsubo cardiomyopathy and co-existing coronary artery disease Stefan Peters ⁎ St. Elisabeth Hospital gGmbH, Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 5 February 2015 Accepted 17 March 2015 Available online 18 March 2015 Keywords: Takotsubo cardiomyopathy Coronary artery disease Apical ballooning
A 75-year old female patient was admitted to the hospital because of chest pain and palpitations.
In the ECG of the patient ST-segment elevation could be excluded. It revealed negative T-waves in lead I, aVL and V4 up to V6. Isolated troponin rise was the laboratory finding. A large apical ballooning was the dominant finding at echocardiography. Angiographically the mid-sized first diagonal branch had a 99% ostial obstruction (Fig. 1), whereas the large left anterior descending artery had several insignificant lesions. The dominant circumflex artery had a 50% obstruction in the periphery of the vessel (Fig. 2). After therapeutic approach with aspirin and clopigodrel the patient no longer had symptoms and the coronary vessels were left without intervention. In conclusion, the diagnosis of takotsubo cardiomyopathy and coronary two-vessel disease not supplying the dysfunctional myocardium was made. According to an article of Parodi et al. published in 2013 [1] 9.6% of patients have either takotsubo cardiomyopathy and additional coronary
Fig. 1. Mid-sized diagonal branch with subtotal lesion.
⁎ St. Elisabeth Hospital gGmbH, Liebenhaller Str. 20, 38259 Salzgitter, Germany. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.03.186 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Fig. 2. Circumflex artery with 50% lesion in the periphery of the vessel.
S. Peters / International Journal of Cardiology 187 (2015) 152–153
artery disease with coronary stenoses not supplying the dysfunctional myocardium. In 90.4% of takotsubo cardiomyopathy patients have irrelevant CAD or angiographically normal coronary arteries. This case report is another example that takotsubo cardiomyopathy and significant coronary artery disease can co-exist in single cases. Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
153
References [1] G. Parodi, R. Citro, B. Bellandi, S. Del Pace, F. Rigo, M. Marrani, et al., Tako-Tsubo cardiomyopathy and coronary artery disease: a pssible association, Coron. Artery Dis. 24 (2013) 527–533.
