Possible association of influenza A infection and reverse takotsubo syndrome

Abstract

We present a case of reverse takotsubo syndrome (rTS) in a 68-year-old woman who presented with acute chest pain and flu-like symptoms. She was found to have elevated troponin and abnormal ECG. Urgent coronary angiogram revealed non-obstructive mild coronary artery disease of the left anterior descending artery. Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. Nasal viral PCR was positive for Influenza A. The diagnosis was confirmed with repeat echocardiogram 2 weeks later revealing resolution of regional wall motion abnormalities. rTS is a type of TS, mimicking acute coronary syndrome. It is seen in younger patients and often occurs with intense emotional and physical stress. Though many triggers have been reported, rTS associated with influenza A has not been previously documented.

Keywords: cardiovascular medicine; cardiovascular system; heart failure; interventional cardiology.

Figure 1

ECG demonstrated ST depressions in leads I and V3–V6.

Figure 2

Coronary angiogram showed non-obstructive mild coronary artery disease of the left anterior descending artery (A: right coronary artery, B: left coronary arteries).

Figure 3

Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. White arrows indicate the areas of normal ventricular movement in the apical segment (A: diastole, B: systole).

Figure 4

Transthoracic echocardiogram on hospital day 2 showed ejection fraction of 63%, normal systolic and diastolic left ventricular function, and hypokinesis of the basal inferior and inferolateral walls (A: diastole, B: systole).