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Case report
‘Acute micro-coronary syndrome’: detailed coronary physiology in a patient with Takotsubo cardiomyopathy
  1. Andrew J Morrow1,2,
  2. Sabrina Nordin1,
  3. Patrick O’Boyle1 and
  4. Colin Berry1,2
  1. 1 Cardiology, Golden Jubilee National Hospital, Clydebank, UK
  2. 2 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Colin Berry, Colin.berry{at}


Takotsubo cardiomyopathy (TC), otherwise known as stress cardiomyopathy, is characterised by acute, transient left ventricular systolic dysfunction with apical ballooning in the absence of obstructive epicardial coronary stenosis. The presentation of TC mimics that of acute myocardial infarction. More recently there has been a shift towards thinking of TC as a ‘microvascular acute coronary syndrome’. Our case is of an 82-year-old woman who presented with TC mimicking acute anterior ST elevation myocardial infarction in the context of sepsis. Slow flow noted in the left anterior descending artery prompted us to perform coronary physiology. Her fractional flow reserve was 0.91, with an index of myocardial resistance of 117 and a coronary flow reserve of 1.6. In combination these results are indicative of microvascular coronary dysfunction in the absence of significant epicardial stenosis.

  • heart failure
  • ischaemic heart disease

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  • Contributors AJM was responsible for patient consent, appropriating data for publication and drafting the manuscript (both case report and discussion). PO’B, SN and CB jointly conceived the project, performed the reported diagnostic procedure and reviewed the manuscript, with each making critical changes prior to submission. CB was the senior consultant in charge of our patient’s care while in our centre and is the senior author of the paper. All authors have given final approval for the current version to be published.

  • Funding This study was funded by the British Heart Foundation (grant RE/13/5/30177).

  • Competing interests CB is employed by the University of Glasgow, which holds consultancy and research agreements with companies that have commercial interests in the diagnosis and treatment of angina. The companies include Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Menarini Pharmaceuticals and Siemens Healthcare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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