Broken Heart Syndrome: A Case Report
A 69-year-old woman with a past history of hypertension was referred to our emergency department with complaints of dizziness and malaise and a transient pre-syncope attack following an intense emotional stress due to witnessing her sister’s death. She did not mention any chest discomfort, retrosternal pain, and dyspnea. She had been taking Aspirin and Valsartan at home. On arrival, her vital signs were stable. A twelve-lead standard electrocardiogram (ECG) showed normal sinus rhythm with slight ST-segment elevation in V1–V3 (about 1 mm) and biphasic T wave changes in V1–V4 (). Routine laboratory tests, including complete blood cells, lipid profile, electrolytes, and liver function tests were all within normal limits except a marked elevation in cardiac enzymes (with a peak level of high sensitive cardiac Troponin T and CK-MB mass within 24 hours after the onset of symptoms, which showed hscTnT 1579 ng/L [reference range < 14ng/L] and CK-MB mass 35.88 ng/L [reference range for females< 3.77ng/ml]).\nEchocardiography results revealed severe left ventricular systolic dysfunction (ejection fraction about 30%) with marked regional wall motion abnormalities in the mid anterior, mid-septal, mid inferior, and apical segments of the left ventricle ().\nThe patient was transferred to the catheterization laboratory, where coronary angiography demonstrated non-obstructive plaques at the mid part of the left anterior descending artery (LAD) and the proximal part of the left circumflex artery (LCX). These findings were consistent with minimal coronary artery disease. Left ventriculography revealed akinesia at the mid-inferior, mid-anteroseptal, and apical segments of the left ventricle. Left ventricular injection showed severe systolic dysfunction. The patient was treated with beta blockers, angiotensin-converting enzyme inhibitors, Aspirin, Clopidogrel, and diuretics. She was discharged from hospital after five days without any complications during the hospital course.\nShe was recommended to be re-evaluated one month afterwards. At the follow-up visit, all the symptoms had disappeared and control echocardiography showed significant improvement in the left ventricular systolic function with a normal ejection fraction (about 60%) and normal wall motion. depicts a comparison between both echocardiographic findings.