Letter to the Editor
An atypical presentation of Tako-Tsubo cardiomyopathy

https://doi.org/10.1016/j.ijcard.2008.06.071Get rights and content

Abstract

We present the case of a patient with Tako-Tsubo cardiomyopathy whose initial diagnosis, based on the location of shoulder and chest pain and electrocardiographic (ECG) changes, suggested that she was suffering from pericarditis. However, 24 h after admission, evolutionary changes of ECG and the echocardiogram performed suggested a Tako-Tsubo cardiomyopathy. In this context, we review the literature to discuss the clinical presentation and evolutionary ECG changes associated with Tako-Tsubo cardiomyopathy.

Section snippets

Case

A 74 year old Brazilian woman arrived in the emergency department presenting shoulder pain. She had a history of hypertension and had had a consultation 8 years prior for chest pain in which a coronary angiogram revealed no lesions. She had no other cardiovascular risks factors. She reported that the onset of shoulder pain was sudden and had lasted for the past 8 h, and that the pain from the shoulder was irradiating to the chest. The pain changed with body position being worse when lying down

Discussion

The present patient, who was an elderly woman, displayed pain of an atypical long duration for ischemia in the left shoulder that irradiated to the chest, acute diffuse ST elevation, apical asynergy, coronary angiogram without any lesions and discrete cardiac troponin T elevation. Her clinical course was consistent with that of Tako-Tsubo left ventricular dysfunction.

The principal features of Tako-Tsubo syndrome are: (a) acute psychological/physical stress before the onset of chest pain; (b)

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [8].

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