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Images in medicine
Reverse Tako-tsubo cardiomyopathy: a clinical entity mimicking acute coronary syndrome INTRODUCTION Tako-Tsubo cardiomyopathy (TC) is an increasingly wellrecognised condition that mimics acute coronary syndrome and is characterised by transient left ventricular (LV) systolic dysfunction without significant coronary artery disease. In recent years, three main variants of TC have emerged: the typical pattern, the reverse pattern and the apical sparing pattern. In typical TC, the LV apex balloons and the apical segments are akinetic (non-contractile) and, to compensate, the basal segments display hyperdynamic function. In reverse TC, there is basal segment akinesia but with normal apical function.
CASE A 56-year-old woman returned from holiday to find that her home had been burgled. Soon after this unfortunate discovery, she developed severe left sided chest pain with breathlessness, nausea and sweating. The pain was unaffected by position or posture and her anterior chest wall was not tender to palpation. She had no past history of cardiovascular disease. Her risk factors included hypertension and a family history of premature coronary disease. Vital signs and physical examination were entirely normal but her 12-lead ECG was abnormal showing sinus rhythm, right
bundle branch block and anterolateral ST-segment depression. Serum high-sensitivity troponin I level was markedly elevated at 6600 ng/L (normal range
Images in medicine
Reverse Tako-tsubo cardiomyopathy: a clinical entity mimicking acute coronary syndrome INTRODUCTION Tako-Tsubo cardiomyopathy (TC) is an increasingly wellrecognised condition that mimics acute coronary syndrome and is characterised by transient left ventricular (LV) systolic dysfunction without significant coronary artery disease. In recent years, three main variants of TC have emerged: the typical pattern, the reverse pattern and the apical sparing pattern. In typical TC, the LV apex balloons and the apical segments are akinetic (non-contractile) and, to compensate, the basal segments display hyperdynamic function. In reverse TC, there is basal segment akinesia but with normal apical function.
CASE A 56-year-old woman returned from holiday to find that her home had been burgled. Soon after this unfortunate discovery, she developed severe left sided chest pain with breathlessness, nausea and sweating. The pain was unaffected by position or posture and her anterior chest wall was not tender to palpation. She had no past history of cardiovascular disease. Her risk factors included hypertension and a family history of premature coronary disease. Vital signs and physical examination were entirely normal but her 12-lead ECG was abnormal showing sinus rhythm, right
bundle branch block and anterolateral ST-segment depression. Serum high-sensitivity troponin I level was markedly elevated at 6600 ng/L (normal range
