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. 2020 Oct 1;96(4):825-829.
doi: 10.1002/ccd.28595. Epub 2019 Nov 6.

Coexistence of acute takotsubo syndrome and acute coronary syndrome

Scott W Sharkey  1 , Ankur Kalra  1 , Timothy D Henry  1   2 , Timothy D Smith  2 , Victoria R Pink  1 , John R Lesser  1 , Ross F Garberich  1 , Martin S Maron  3 , Barry J Maron  1   3
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Coexistence of acute takotsubo syndrome and acute coronary syndrome

Scott W Sharkey et al. Catheter Cardiovasc Interv. .

Abstract

Background: Takotsubo syndrome (TS) is an acute cardiac condition with presentation indistinguishable from acute coronary syndrome (ACS), and mechanism independent of epicardial coronary obstruction. Acute coronary artery plaque rupture/occlusion is not expected in TS. Nonetheless, the physiologic stress of ACS might itself trigger TS, leading to coexistence of both conditions, and diagnostic uncertainty.

Methods: From 2011 to 2014, we encountered 137 consecutive patients with typical TS (without acute coronary plaque rupture/occlusion). During this time, among a population of 3,506 consecutive ACS patients, nine (0.3%) presented with features of both ACS and TS, that is, acute onset, troponin elevation, acute plaque rupture/occlusion, and reversible LV ballooning not corresponding to culprit coronary distribution.

Results: The nine patients (seven female) with TS-ACS coexistence, average age 70 ± 13 years, presented with chest pain (n = 6), nausea/vomiting (n = 2), or cardiac arrest (n = 1), ST-elevation (n = 5), all with troponin elevation (peak 1.3 ± 1.2 ng/ml). Each had single vessel coronary disease; right coronary (n = 3), circumflex (n = 3), mid-LAD (n = 2), ramus intermedius (n = 1), with percutaneous coronary intervention in seven patients (78%). Initial ejection fraction was 26 ± 7%, with apical ballooning in eight patients and mid-LV ballooning in one patient. Each patient had LV ballooning resolution and ejection fraction normalization to 57 ± 3%, hospital survival was 89%.

Conclusions: Among patients with ACS, a subset have evidence of coexisting TS, findings which further expand the clinical profile of both conditions, raising the possibility that ACS itself may trigger TS.

Keywords: acute coronary syndrome; takotsubo cardiomyopathy; takotsubo syndrome.

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References

REFERENCES

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