Dynamics of electrocardiographic changes, brain-natriuretic peptide and cortisol levels in a patient with stress (takotsubo) cardiomyopathy: A case report

Abstract

Introduction. Takotsubo cardiomyopathy is a transient acute heart failure syndrome caused by stress that provokes left ventricular mid-apical akinesis and mimics acute coronary syndrome. Case report. A 66-year-old woman had chest pain and dispnoea a few hours before hospitalization. A sudden emotional stressful event preceded the symptoms. Electrocardiographic abnormalities - precordial ST elevation and modest increase of cardiac troponin mimiced acute myocardial infarction. However, echocardiographic examination showed apical ballooning with markedly diminished left ventricle ejection fraction and the obstruction in the outflow tract of the left ventricle. Coronary angiography at admission showed no coronary stenosis and slower blood flow through the left anterior descending artery. According to anamnesis, echocardiography and coronarography finding we established the diagnosis of stress cardiomyopathy - takotsubo cardiomyopathy. We described in details the slow but dynamic electrocardiographic changes, levels of brain natriuretic peptide, cortisol and echocardiography evolution of disease during a 4-month follow-up till the full recovery. Conclusion. Stress (takotsubo) cardiomyopathy - became an important differential diagnosis of acute anterior myocardial infarction and it should be reconsidered every time when emotionally stressed patients with transient-apical akinesis or dyskinesis of the LV are present.Uvod. Takotsubo kardiomiopatija je sindrom prolazne akutne srcane slabosti izazvan stresom koji dovodi do apikalne akinezije leve komore i podrazava akutni koronarni sindrom. Prikaz bolesnika. U radu je prikazana 66- togodisnja zena sa bolovima u grudnom kosu i gusenjem nastalim nekoliko casova pre hospitalizacije. Iznenadni emocionalni stres predhodio je simptomima. Elektrokardiografske promene ST-segmenta (elevacija) i umereni porast kardiospecificnih enzima podrazavali su akutni infarkt miokarda. Ehokardiografija je pokazala apikalno baloniranje sa znacajno snizenom ejekcionom frakcijom leve komore i sa opstrukcijom u izlaznom traktu leve komore. Koronarna angiografija ucinjena po prijemu pokazala je odsustvo stenoza krvnih sudova srca i usporeni tok krvi kroz levu koronarnu arteriju. U skladu sa anamnezom, ehokardiografijom i nalazom koronarografije postavljena je dijagnoza: stres kardiomiopatija - takotsubo. Detaljno je opisana spora, ali dinamicna evolucija bolesti tokom cetiri meseca pracenja sve do potpunog oporavka. Zakljucak. Stres (takotsubo) kardiomiopatija postala je bitna diferencijalna dijagnoza akutnog infarkta prednjeg zida i treba je uzeti u razmatranje kad god imamo bolesnika izlozenog jakom emocionalnom stresu sa apikalnim baloniranjem leve komore srca.