A mimicry of an acute coronary syndrome.
BACKGROUND
A 79-year-old woman was out in the garden having lunch on a hot summer's 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 ago, no history of diabetes or hypertension. There was a family history of her father having a myocardial infarction at the age of 54. ECG revealed widespread deep symmetrical T-wave inversion in the chest leads and lateral limb leads.


METHODS
The patient's serum creatine kinase level was 180 IU/l (normaL range 30-135), troponin I level was 6.56 g/l (normal range 0-0.10), D-dimer was negative and random serum cholesterol level was 5.3 mmol/l (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.


METHODS
Takotsubo cardiomyopathy.


RESULTS
Treatment with aspirin, ACE inhibitor, beta blocker and a statin.
Teo
Bervin
B
Ashford and St Peter's Hospitals NHS Trust, Ashford Hospital, London Road, Ashford, Middlesex TW15 3AA, UK. bervinteo@yahoo.com
D000208:Acute Disease; D000368:Aged; D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*