Combination of acute myocardial infarction and Takotsubo syndrome

Abstract

A 79-year-old woman was admitted to the emergency department of cardiology after transient loss of consciousness episode and a recorded ventricular tachycardia. The ST segment elevation in I, aVL, V1-V5 leads up to 6 mm and ST-segment depression up to 1 mm in III, aVF were registered at admission. The emergency coronary angiography showed of slowed coronary blood flow without stenosing atherosclerosis. The diagnosis of acute myocardial infarction was based on: 1. The typical progression of ECG: ST elevation resolved and the T wave become inverted; 2. The transient increasing CK up to 439 U/l, CK-MB up to 52 U/l and troponin I up to 5.8 ng/ml; 3. The inclusion of paramagnetic in the myocardium in the anterior wall and septum of LV by the type of ischemic damage. The diagnosis of Takotsubo syndrome based on rapid and complete recovery of contractility and geometry of the left ventricle (LV). At the 2nd day LV ejection fraction was 21%; the dyskinesis, akinesis of the anterior and antero-lateral walls of the left ventricle were registered. At the 7th day the hypokinesis zones was not detected. The article discusses the literature data on the frequency of combination of these diseases and possible pathogenetic mechanisms of this combination.