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Chest pain after elective percutaneous coronary intervention as trigger of takotsubo syndrome—a case report

Year: 2024

Type: article

Abstract: Background: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. It usually presents with clinical features similar to acute coronary syndrome, making its occurrence following elective percutaneous coronary intervention (PCI) challenging to diagnose and treat. Case summary: A 67-year-old man with ischaemic heart disease and recurrent angina underwent elective PCI of the right coronary artery. The procedure, although technically challenging, was completed without immediate complications. However, shortly after the intervention, the patient experienced acute chest pain, initially thought to be due to subocclusion of a postero-lateral branch, which was treated with balloon angioplasty. Despite this intervention, the patient developed severe ventricular arrhythmias and exhibited dynamic electrocardiographic changes and echocardiographic features consistent with TTS. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis, revealing classic apical ballooning and left ventricular dysfunction. With comprehensive medical management and haemodynamic support, the patient gradually recovered. He was discharged after stabilization, with follow-up showing complete resolution of the left ventricular dysfunction. Discussion: This case highlights the importance of recognizing TTS as a potential complication following PCI, particularly in patients with a heightened stress response. It emphasizes the need for increased awareness and the use of advanced diagnostic tools, such as CMR imaging, to accurately identify TTS. Early diagnosis and appropriate management are crucial for improving outcomes, especially in complex PCI cases where TTS can mimic more common coronary complications.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytae694

Authors: Vincenzo Castiglione, Chiara Arzilli, Marco Ciardetti, Michele Emdin, Michele Coceani

Institutions: Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio

Language: English

Topic: Takotsubo Cardiomyopathy and Associated Phenomena

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $819