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02 January 2020 : Case report  Lebanon

Mid-Ventricular Takotsubo Cardiomyopathy with Hawk’s Beak Appearance: A Case Report

Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Anthony Matta12ABCDEFG*, Jerome Roncalli2ABCD, Meyer Elbaz2ABE, Thibault Lhermusier2ABE, Francisco Campelo-Parada2ABE, Frederic Bouisset2AB, Khaled Elenizi3ABCDEFG, Vanessa Nader4ABE, Didier Carrié2ABCE

DOI: 10.12659/AJCR.919563

Am J Case Rep 2020; 21:e919563

Abstract

BACKGROUND: Takotsubo cardiomyopathy is a myocardial infarction-like clinical entity commonly occurring after a stressful incident, leading to reversible systolic dysfunction. It involves several subtypes, most often associated with a good prognosis; however, a late diagnosis can contribute to a poor cardiovascular outcome.

CASE REPORT: We report an unusual case of mid-ventricular takotsubo cardiomyopathy in a 76-year-old woman who presented with recent-onset shortness of breath and compressive chest pain, typically characterized by a hawk’s beak shape on left ventriculogram, highlighting the importance of this helpful descriptive but little-known fluoroscopic sign. The final diagnosis was made using transthoracic echocardiography, contrast-enhanced pulmonary angiography, coronary angiography, and left ventriculography. She was successfully treated by beta-blockers and angiotensin-converting enzyme inhibitor, with a good clinical outcome evaluated at 3-month follow-up after hospital discharge.

CONCLUSIONS: Ventriculography is an important tool for use in making the differential diagnosis in patients presenting with acute coronary syndrome without obstructive coronary artery disease. The hawk’s beak shape is an early fluoroscopic diagnostic marker characterizing the mid-ventricular subtype of takotsubo.

Keywords: acute coronary syndrome, case reports, takotsubo cardiomyopathy, Aged, Coronary Angiography, Diagnosis, Differential, Echocardiography, Heart Ventricles, Myocardial Infarction, Radionuclide Ventriculography

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923