Dynamic Takotsubo Syndrome: When SCAD Hides in a Pot

Abstract

Both Takotsubo cardiomyopathy and spontaneous coronary artery dissection (SCAD) of the distal portion of the left anterior descending artery affect the apical myocardium. It is important to distinguish between both diseases, because therapy and follow-up differ. Revascularization may be lifesaving in SCAD, whereas heart failure management is vital in Takotsubo cardiomyopathy. (Level of Difficulty: Intermediate.).

Keywords: ACE, angiotensin-converting enzyme; ECG, electrocardiography; FMD, fibromuscular dysplasia; LAD, left anterior descending artery; LCX, left circumflex artery; PE, pulmonary embolism; RCA, right coronary artery; SCAD, spontaneous coronary artery dissection; TC, Takotsubo cardiomyopathy; TTE, transthoracic echocardiography; acute coronary syndrome; case series; coronary angiography; spontaneous coronary artery dissection; takotsubo cardiomyopathy.

Graphical abstract

Figure 1

First Angiogram of Patient 1: SCAD of LCX The first angiogram of Patient 1 shows moderate stenosis of the distal LCX (white arrow), suspected for SCAD. D1 = first diagonal branch; LAD = left anterior descending artery; LCX = circumflex artery; SCAD = spontaneous coronary artery dissection.

Figure 2

First Angiogram of Patient 1: No SCAD of RCA The first angiogram in Patient 1 shows right coronary artery without stenosis. RCA = right coronary artery; SCAD = spontaneous coronary artery dissection.

Figure 3

First Angiogram of Patient 1: SCAD of LAD The first angiogram of Patient 1 shows a narrow lumen in the distal part of the LAD (white arrows), suspected for spontaneous coronary artery dissection after review. D1 = first diagonal branch; other abbreviations as in Figure 1.

Figure 4

Second Angiogram of Patient 1: Type I SCAD of LCX The second angiogram of Patient 1 shows type I SCAD of the distal portion of the LCX (white arrow) with subsequent occlusion (white arrowheads). Abbreviations as in Figure 1.

Figure 5

Second Angiogram of Patient 1: Type IIb SCAD of RCA The second angiogram of Patient 1 shows type IIb SCAD of the distal portion of the RCA with partial occlusion. (white arrowheads) Abbreviations as in Figures 1 and 2. .

Figure 6

Second Angiogram of Patient 1: No SCAD of LAD The second angiogram of Patient 1 shows normal caliber of the distal part of the LAD (white arrows). Abbreviations as in Figure 1.

Figure 7

Third Angiogram of Patient 1: No SCAD of LCX The third angiogram of Patient 1 shows complete resolution of lesion in the LCX (white arrows). Abbreviations as in Figure 1.

Figure 8

Third Angiogram of Patient 1: No SCAD of RCA The third angiogram of Patient 1 shows complete resolution of the lesion in the RCA. Abbreviations as in Figures 1 and 2.

Figure 9

Third Angiogram of Patient 1: No SCAD of LAD The third angiogram of Patient 1 shows normal caliber of the distal part of the LAD (white arrows). Abbreviations as in Figure 1.

Figure 10

Second Angiogram of Patient 2 The second angiogram of Patient 2 shows type IIb SCAD of the first diagonal branch of the LAD (white arrows). Abbreviations as in Figure 1.

Figure 11

First Angiogram of Patient 2 The first angiogram of Patient 2 shows type IIb SCAD of the distal LAD (white arrows) and a diagonal branch. OM1-OM3 = obtuse marginal artery 1-3; other abbreviations as in Figure 1.