Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Anthony Matta, Jerome Roncalli, Meyer Elbaz, Thibault Lhermusier, Francisco Campelo-Parada, Frederic Bouisset, Khaled Elenizi, Vanessa Nader, Didier Carrié
Cardiology Division, Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
Am J Case Rep 2020; 21:e919563
Available online: 2020-01-02
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