Accepted Manuscript A Stressful Angiogram: Acute Takotsubo Cardiomyopathy Roberto Spina, MBBS Michael Feneley, MBBS PII:
S0735-1097(14)01680-5
DOI:
10.1016/j.jacc.2014.01.074
Reference:
JAC 20021
To appear in:
Journal of the American College of Cardiology
Received Date: 20 December 2013 Accepted Date: 28 January 2014
Please cite this article as: Spina R, Feneley M, A Stressful Angiogram: Acute Takotsubo Cardiomyopathy, Journal of the American College of Cardiology (2014), doi: 10.1016/j.jacc.2014.01.074. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT A Stressful Angiogram: Acute Takotsubo Cardiomyopathy
Brief Title:
A Stressful Angiogram
Authors:
Roberto Spina MBBS, Department of Cardiology, St Vincent’s Hospital, Sydney, Australia; Professor Michael Feneley MBBS, Department of Cardiology, St Vincent’s Hospital, Sydney, Australia.
Disclosures:
None
Correspondence:
Professor Michael Feneley MBBS 390 Victoria Street, Darlinghurst, Sydney, NSW, Australia, 2010 Ph: +61 2 83821111 Fax: +61 2 83822359 Email: [email protected]
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ACCEPTED MANUSCRIPT A 62 year old lady presented to our institution with severe chest discomfort which developed shortly after she received unexpected, and negative, news about the denouement of a longstanding court case she was involved in. The patient was intensely apprehensive prior to cardiac catheterization. Left ventriculography demonstrated apical ballooning suggestive of
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stress, or Takotsubo, cardiomyopathy (Figure 1). Approximately 8 minutes into the angiographic study of the left coronary system, she developed severe retrosternal discomfort, similar in nature to the pain experienced on presentation, together with ST-segment elevation
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in the inferior leads and hypotension. The left coronary system appeared angiographically normal throughout the procedure (Figure 2). The catheter in left main coronary artery ostium
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was rapidly disengaged. Upon catheter engagement of the right coronary artery (RCA) for the first time, the coronary slow-flow phenomenon was observed (Video 1). Upon resumption of normal coronary flow, the RCA appeared unobstructed throughout its course (Video 2). On careful review of the angiographic cine-loops, no evidence of coronary vasospasm, air
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embolism, myocardial bridging or dissection could be identified. Her chest discomfort
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resolved within one hour and she made an uneventful recovery.
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S0735-1097(14)01680-5
DOI:
10.1016/j.jacc.2014.01.074
Reference:
JAC 20021
To appear in:
Journal of the American College of Cardiology
Received Date: 20 December 2013 Accepted Date: 28 January 2014
Please cite this article as: Spina R, Feneley M, A Stressful Angiogram: Acute Takotsubo Cardiomyopathy, Journal of the American College of Cardiology (2014), doi: 10.1016/j.jacc.2014.01.074. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT A Stressful Angiogram: Acute Takotsubo Cardiomyopathy
Brief Title:
A Stressful Angiogram
Authors:
Roberto Spina MBBS, Department of Cardiology, St Vincent’s Hospital, Sydney, Australia; Professor Michael Feneley MBBS, Department of Cardiology, St Vincent’s Hospital, Sydney, Australia.
Disclosures:
None
Correspondence:
Professor Michael Feneley MBBS 390 Victoria Street, Darlinghurst, Sydney, NSW, Australia, 2010 Ph: +61 2 83821111 Fax: +61 2 83822359 Email: [email protected]
AC C
EP
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M AN U
SC
RI PT
Title:
1
ACCEPTED MANUSCRIPT A 62 year old lady presented to our institution with severe chest discomfort which developed shortly after she received unexpected, and negative, news about the denouement of a longstanding court case she was involved in. The patient was intensely apprehensive prior to cardiac catheterization. Left ventriculography demonstrated apical ballooning suggestive of
RI PT
stress, or Takotsubo, cardiomyopathy (Figure 1). Approximately 8 minutes into the angiographic study of the left coronary system, she developed severe retrosternal discomfort, similar in nature to the pain experienced on presentation, together with ST-segment elevation
SC
in the inferior leads and hypotension. The left coronary system appeared angiographically normal throughout the procedure (Figure 2). The catheter in left main coronary artery ostium
M AN U
was rapidly disengaged. Upon catheter engagement of the right coronary artery (RCA) for the first time, the coronary slow-flow phenomenon was observed (Video 1). Upon resumption of normal coronary flow, the RCA appeared unobstructed throughout its course (Video 2). On careful review of the angiographic cine-loops, no evidence of coronary vasospasm, air
TE D
embolism, myocardial bridging or dissection could be identified. Her chest discomfort
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EP
resolved within one hour and she made an uneventful recovery.
2
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