Subacute stent thrombosis and stress-induced cardiomyopathy: trigger or consequence?

Abstract

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy (TCM) is a unique syndrome, characterized by transient left ventricular (LV) apical ballooning without significant coronary arteries stenosis, affecting mainly menopausal women. We present the case of a 70 year old woman with subacute stent thrombosis (ST) at the level of the right coronary artery and transient apical ballooning with normal flow of left and circumflex coronary arteries. TCM is frequently associated with emotional stress, but to date no case of ST triggering TCM have been reported.

Keywords: Stress-induced cardiomyopathy; Takotsubo cardiomyopathy; subacute stent thrombosis.

Figure 1

Coronary angiograms showing: A subtotal occlusion (99%) of the right coronary artery and B the good angiographic outcome after primary percutaneous coronary intervention with stent.

Figure 2

Coronary angiograms showing the absence of significant luminal obstructions of left and circumflex coronary arteries: A during the first and B the second coronary angiography.

Figure 3

Electrocardiograms showing: A sinus tachycardia with ST-elevation in leads D2-D3-aVF and B diffuse T-inversion and QT prolongation.

Figure 4

Bi-dimensional transthoracic echocardiogram apical four-chamber views in diastole A and systole B, showing apical ballooning with intra-cardiac thrombus.

Figure 5

Coronary angiogram showing: A subacute stent thrombosis at the level of the right coronary artery and B flow restoring after revascularization with stent.