From atropine eye drops to takotsubo syndrome in an 89-year-old lady

A few hours after receiving atropine drops for an eye examination, an 89-year-old lady complained of compressive chest pain that was associated with an ST-segment elevation in the anterolateral and inferior leads. Emergency coronary angiography showed normal coronary arteries; however, contrast ventriculography showed an “apical ballooning” pattern (octopus trap) in end systole that is typical of takotsubo syndrome. The left ventricular function, monitored by a 2D echocardiogram, fully recovered at follow-up. Atropine eye drops can have systemic effects, especially in the elderly, inducing, through a sympathetic imbalance, an acute coronary microvascular dysfunction that may trigger takotsubo syndrome in the absence of classic emotional stress. This case report provides support for the hypothesis that takotsubo syndrome is a manifestation of acute microvascular dysfunction. L Heart Metab. 2018;75:29-32