JACC. Case reports · 2026
Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Mondal Avilash, Thangjui Sittinun, Taha Amro, Conte Justin, Challa Abhiram, Bianco Christopher, Balla Sudarshan, Biederman Robert W W
Аннотация
BACKGROUND: Takotsubo syndrome can present with ST-segment elevation, mimicking acute coronary syndrome. Dynamic left ventricular outflow tract (LVOT) obstruction often is a hemodynamic collapse in these patients.
CASE SUMMARY: A 64-year-old woman presented with epigastric discomfort and nausea. Initial electrocardiography showed hyperacute T waves in V3-V6, followed by acute inferior ST-segment elevation and reciprocal changes. Coronary angiography revealed no obstructive disease; however, there was global hypokinesia with basal hyperkinesis in left ventriculography. She developed cardiogenic shock requiring vasopressors, and decision was made to place a balloon pump for hemodynamic support. Echocardiography demonstrated systolic anterior motion of the mitral valve and dynamic LVOT obstruction (peak gradient 48 mm Hg). Alpha-1 agonist agents led to clinical improvement and stable discharge.
DISCUSSION: In Takotsubo syndrome, identifying LVOT obstruction, avoiding afterload reducers, and optimizing preload are key.
TAKE-HOME MESSAGE: In electrocardiogram-based ST-segment elevation myocardial infarction, Takotsubo syndrome must be considered as a differential.
CASE SUMMARY: A 64-year-old woman presented with epigastric discomfort and nausea. Initial electrocardiography showed hyperacute T waves in V3-V6, followed by acute inferior ST-segment elevation and reciprocal changes. Coronary angiography revealed no obstructive disease; however, there was global hypokinesia with basal hyperkinesis in left ventriculography. She developed cardiogenic shock requiring vasopressors, and decision was made to place a balloon pump for hemodynamic support. Echocardiography demonstrated systolic anterior motion of the mitral valve and dynamic LVOT obstruction (peak gradient 48 mm Hg). Alpha-1 agonist agents led to clinical improvement and stable discharge.
DISCUSSION: In Takotsubo syndrome, identifying LVOT obstruction, avoiding afterload reducers, and optimizing preload are key.
TAKE-HOME MESSAGE: In electrocardiogram-based ST-segment elevation myocardial infarction, Takotsubo syndrome must be considered as a differential.