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Coexistence of acute takotsubo syndrome and acute coronary syndrome
Author(s) -
Sharkey Scott W.,
Kalra Ankur,
Henry Timothy D.,
Smith Timothy D.,
Pink Victoria R.,
Lesser John R.,
Garberich Ross F.,
Maron Martin S.,
Maron Barry J.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28595
Subject(s) - medicine , acute coronary syndrome , cardiology , chest pain , ejection fraction , percutaneous coronary intervention , culprit , coronary occlusion , myocardial infarction , troponin , st elevation , troponin t , heart failure
Background Takotsubo syndrome (TS) is an acute cardiac condition with presentation indistinguishable from acute coronary syndrome (ACS), and mechanism independent of epicardial coronary obstruction. Acute coronary artery plaque rupture/occlusion is not expected in TS. Nonetheless, the physiologic stress of ACS might itself trigger TS, leading to coexistence of both conditions, and diagnostic uncertainty. Methods From 2011 to 2014, we encountered 137 consecutive patients with typical TS (without acute coronary plaque rupture/occlusion). During this time, among a population of 3,506 consecutive ACS patients, nine (0.3%) presented with features of both ACS and TS, that is, acute onset, troponin elevation, acute plaque rupture/occlusion, and reversible LV ballooning not corresponding to culprit coronary distribution. Results The nine patients (seven female) with TS‐ACS coexistence, average age 70 ± 13 years, presented with chest pain ( n = 6), nausea/vomiting ( n = 2), or cardiac arrest ( n = 1), ST‐elevation ( n = 5), all with troponin elevation (peak 1.3 ± 1.2 ng/ml). Each had single vessel coronary disease; right coronary ( n = 3), circumflex ( n = 3), mid‐LAD ( n = 2), ramus intermedius ( n = 1), with percutaneous coronary intervention in seven patients (78%). Initial ejection fraction was 26 ± 7%, with apical ballooning in eight patients and mid‐LV ballooning in one patient. Each patient had LV ballooning resolution and ejection fraction normalization to 57 ± 3%, hospital survival was 89%. Conclusions Among patients with ACS, a subset have evidence of coexisting TS, findings which further expand the clinical profile of both conditions, raising the possibility that ACS itself may trigger TS.