Acute myocardial infarction with "wrap around" right coronary artery mimicking Takotsubo cardiomyopathy: a case report.
BACKGROUND
Takotsubo cardiomyopathy (TC) is a cardiomyopathy that shows distinctive clinical conditions first described more than 20 years ago. Because clinical features of TC mimic those of anterior acute myocardial infarction (AMI), the differential diagnosis is important in selecting the appropriate treatment strategy in the acute phase. But it was difficult to differentiate those two diseases because the TC-like findings; such as the electrocardiogram (ECG) changes and left ventricular wall motion abnormality can occur in AMI especially with the anatomical variance of the coronary artery.


METHODS
A 63-year-old man was admitted due to sudden onset of chest pain and was in a cardiogenic shock state. His ECG showed ST-segment elevation in precordial (V2-6) and inferior leads (II, III, and aVF) and ST-segment depression in lead aVR. Blood biochemistry showed that cardiac enzymes were not elevated. Ultrasonic cardiography showed that the left ventricular apical level was akinetic, papillary muscle level was severely hypokinetic, and basal level was hyperkinetic, mimicking TC. However, coronary angiogram showed total occlusion of his right coronary artery wrapping around the cardiac apex. Successful percutaneous coronary intervention reversed his critical status.


CONCLUSIONS
To our knowledge, the present case is the first report described AMI with wrap-around RCA, mimicking TC. Although TC is increasingly recognized as a true but relatively infrequent clinical entity, it is still important to carefully rule out obstructive coronary artery disease.
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan. hs.vxvii@gmail.com.
Hiroki
H
Shibutani
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Yuzo
Y
Akita
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Kotaro
K
Yutaka
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Satoshi
S
Yamamoto
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Yumie
Y
Matsui
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Masahiro
M
Yoshinaga
Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Masahiro
M
Karakawa
Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitayama, Taisho-ku, Osaka, 551-0032, Japan.
Yasukiyo
Y
Mori
D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*
Acute myocardial infarction; Apical ballooning syndrome; Coronary artery anomaly; Ischemic heart disease; Takotsubo cardiomyopathy