Recurrence of Takotsubo Cardiomyopathy: Role of Multi-Detector Computed Tomography Coronary Angiography
A 58-year-old woman with a history of TCM was admitted to the emergency department due to severe dyspnea accompanied by a sudden-onset, prolonged, burning chest pain and palpitation, similar to those she had experienced in her initial admission, while she was on β-blocker. The occurrence and recurrence of TCM were triggered by emotional and physical stress (anger and prolonged dancing at a wedding ceremony), respectively. At the time, transthoracic echocardiography had revealed akinesia of the LV, with the exception of the basal regions, and in addition, cardiac catheterization had demonstrated minimal coronary artery disease and follow-up transthoracic echocardiography had shown normalization of the LV wall motion abnormalities (ejection fraction = 60%). This time on arrival, the patient had a blood pressure of 120/80 mmHg, pulse rate of 117 beats per minute, and respiratory rate of 35 breaths/minute. The only finding on physical examination was bilateral coarse crackles over both lung bases. The admission surface electrocardiogram (ECG) showed sinus tachycardia, slight ST elevation in V1 through V4 with shallow inverted T waves, and slow R progression (). Although the patient’s symptoms subsided to a great extent on the first day of admission, serial ECGs showed marked dynamic changes: deeply inverted T waves were formed and QT intervals became significantly prolonged ().\nTransthoracic echocardiography on admission revealed a normal LV size with severe LV systolic dysfunction (ejection fraction = 20–25%) and akinesia of the LV with the exception of the basal regions. The serum levels of CK-MB and high sensitive troponin T were 6.32 ng/mL (reference range for females < 3.77 ng/mL) and 213.8 ng/L (reference range < 14 ng/L).\nClinical presentation, compatible TCM past history, and paraclinical findings were all in favor of this diagnosis. Given her previous normal cardiac-catheterization, conducted five months previously, coronary arteries were evaluated via a less invasive procedure, namely MDCT, which revealed no significant findings in the epicardial coronary arteries ().\nThe patient’s hospital course was uneventful, and she was discharged in good condition on hospital day 9. On the follow-up visit, 3 months later, she was symptom free and all of the ECG () and transthoracic echocardiography abnormalities were almost completely resolved.