An atypical evolution of tako-tsubo cardiomyopathy.

An 83-year-old woman with a possible history of myocardial infarction presented with acute chest pain and dyspnoea. The electrocardiogram showed no signs of acute coronary syndrome, but Q waves in the anteroseptal leads. The blood tests showed an important elevation of troponin T level. Emergency coronary angiography revealed normal epicardial arteries, but the left ventriculogram demonstrated anterior akinesis and ballooning with normal apical and basal function. An atypical takotsubo cardiomyopathy was suspected and the patient received beta blocker and ACE inhibitor treatment. Two days later the echocardiogram evolved to a classical pattern of apical ballooning with normalization on the follow-up examination 5 weeks from the acute episode. To our knowledge, this is the first case report describing an evolving pattern of wall motion abnormality from an anterior wall ballooning to an apical form.