Tako-Tsubo Phenomenon: Dual-Source CT and Conventional Coronary Angiography

A 75-year-old woman was admitted to our emergency department with severe chest pain and mild dyspnea that started soon after a marital quarrel with her husband. Her 12-lead electrocardiogaphy (ECG) demonstrated an ST elevation in the precordial leads, and the plasma troponin T level was elevated to 0.29 ng/mL. An acute myocardial infarction with ST elevation was assumed, and the patient was admitted for an emergency catheter coronary angiography.

Her coronary arteries were normal, but left ventriculography demonstrated a severe systolic dysfunction involving the mid and apical myocardial segments, showing apical ballooning (Supplemental Data Movie I). Thus, the diagnosis of tako-tsubo phenomenon was made.

The ejection fraction was decreased to 40 %. Because of a history of pulmonary embolism, the patient was referred for chest computed tomography (CT) to rule out a recurrent pulmonary embolism. Contrast-enhanced, retrospectively ECG-gated dual-source CT excluded pulmonary embolism and similarly demonstrated systolic dysfunction with apical ballooning (Supplemenal Data Movie II). After 2 days, the patient’s symptoms ceased and echocardiography showed normalized left ventricular systolic function.

Authors:
Hans Scheffel, Paul Stolzmann, Christoph Karlo, Pedro Trigo-Trindade, Borut Marincek, Thomas F. Luescher, Hatem Alkadhi

Full text available on: Cardiovasc Intervent Radiol. 2008 Jan-Feb;31(1):226-7. Epub 2007 Aug 4