Case report: Takotsubo syndrome following percutaneous coronary intervention

Abstract

Background: Takotsubo syndrome (TTS), which is frequently secondary to severe emotional (fear, anxiety, etc.) or physical stress, is an acute reversible heart failure syndrome characterized by temporary left ventricular regional systolic dysfunction. Nevertheless, TTS after percutaneous coronary intervention (PCI) is rare, and its clinical characteristics are easily confused with complications after PCI.

Case presentation: This article reports a case of TTS induced by psychological and physical pressure after successful PCI in our institution. The patient had symptoms comparable to complications after PCI, including V1-V5 ST segment elevation and T wave changes of electrocardiogram (ECG) and troponin elevation. Coronary angiogram, left ventricle opacification (LVO), and cardiac magnetic resonance (CMR) were performed to exclude postoperative complications. Diagnosis of TTS was eventually achieved.

Conclusion: We cannot dismiss the risk of TTS in patients who have unexplained V1-V5 ST segment elevation and T wave changes of ECG and troponin elevation following successful PCI. Meanwhile, medical personnel should provide mental, cultural, and emotional services to patients in addition to essential diagnostic and treatment technical services during the perioperative period.

Keywords: Differential diagnosis; Mental service; Percutaneous coronary intervention (PCI); Takotsubo syndrome (TTS).

Fig. 1

Hs-TnI and pro-BNP trend chart

Fig. 2

Dynamic ECG changes from admission to 7 days after PCI. (A) ECG on admission;(B) ECG on Day 1 after PCI; (C) ECG on Day 4 after PCI; (D) ECG on Day 7 after PCI.

Fig. 3

Normal echocardiography at admission (A). LVO on Day 1 after PCI shows the middle and lower segments of the ventricular septum, the anterior wall of the left ventricle, and the ventricular wall of the apical segment (arrow) at the onset of Takotsubo syndrome (B). On day 7 after PCI, only slight akinesia with a normal ejection fraction of 65% can be seen (C). Normal LVO at 2 months later (D)

Fig. 4

Coronary angiograms. (A-B) 3 coronary arteries before PCI. (C-D) Left coronary artery after PCI. (E-F) Re-examination of coronary angiogram following abnormal ECG.

Fig. 5

Comparison of CMR on Day 4 after PCI (A-C) and at 2 months follow-up (D-F). Before treatment, B-TEF four chamber showed the middle segments of the ventricular septum and left ventricular apex area are irregular in shape, with bulge of the regional area (A). T2-SPIR showed slightly increased signal intensity with edema in the left ventricular apex area (B). PSIR-TFE four chamber showed no late gadolinium enhancement. After treatment, these abnormalities were resolved (D-F).