Background: A 79-year-old woman was out in the garden having lunch on a hot summer day. She developed stabbing chest pains, more severe on her left side, associated with radiation down her left arm. Severity was 7 out of 10. There was no relief of pain with glyceryl trinitrate spray. Risk factors for ischaemic heart disease include hyperlipidaemia, being an ex-smoker (40 years), no history of diabetes or hypertension. There was a family history of her father having a myocardial infarction at the age of 54. Echocardiogram (ECG) revealed widespread deep symmetrical T-wave inversion in the chest leads and lateral limb leads.
Investigations: The patient’s serum creatine kinase level was 180 IU/litre (normal range 30–135), troponin I level was 6.56 g/litre (normal range 0–0.10), D-dimer was negative and random serum cholesterol level was 5.3 mmol/litre (3.8–5.2). Significant coronary stenoses were excluded. A left ventriculogram revealed a hyperkinetic base and a dyskinetic apical region of the left ventricle. Echocardiography showed normal valves, basal septal hypertrophy and a dilated akinetic apex, with the region of akinesia spanning more than the arterial territory.
Diagnosis: Takotsubo cardiomyopathy.
Management: Treatment with aspirin, angiotensin-converting enzyme (ACE) inhibitor, β blocker and a statin
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Competing interests: none.
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