The ¨Broken Heart Syndrome¨: Takotsubo Cardiomyopathy

Case Report: Chest pain after emotional and physical upset

A 61 year old white woman attended her local accident and emergency department with severe central chest pain. After being chased by two large dogs. The pain was not relieved by nitroglycerine spray given in the ambulance. An electrocardiogram showed anterolateral ST segment depression, with an elevated troponin T of 1.25 μg/l. She had no cardiovascular risk factors. Non-ST elevation myocardial infarction was diagnosed, and the patient was treated accordingly.
Coronary angiography showed normal coronary arteries, but the left ventriculogram showed a large area of apical hypokinesis with moderate impairment of left ventricular systolic function.
The patient was readmitted several weeks later with further chest pain. An electrocardiogram showed no new changes with no rise in the cardiac troponin. An echocardiogram showed that her left ventricular systolic function had almost returned to normal.