Abstract
An 81-year-old man was referred to our emergency department with severe persistent chest pain. One year before presentation at our department, his 12-lead electrocardiogram (ECG) revealed a normal QRS pattern during the period of normal conduction with intermittent left bundle branch block (LBBB). His ECG immediately after arrival showed deep T-wave inversion in the precordial leads during normal conduction. During LBBB, there was mild ST-segment elevation with poor R-wave progression across the precordial leads. Emergent cardiac catheterization was performed to rule out acute coronary syndrome. Coronary angiography showed no significant stenosis, and coronary spasm was not provoked by the administration of intracoronary ergonovine. Left ventriculography demonstrated persistent left ventricular apical akinesis with systolic ballooning. Based on these findings, the patient was diagnosed to have takotsubo cardiomyopathy (TCM). After 6 months, echocardiography demonstrated the recovery of the left ventricular regional wall motion abnormality. An ECG performed 6 months after the presentation showed incomplete resolution of T-wave inversion in the periods of normal conduction. ST elevation and poor R-wave progression were improved during LBBB. In a case with acute chest pain and an ECG changes incompatible with acute ischemia superimposed on a pattern of LBBB, TCM should be considered as a differential diagnosis.
Similar content being viewed by others
References
Dote K, Sato H, Tateishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multi-vessel coronary spasms: a review of 5 cases. J Cardiol 21:203–214
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008) Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 118:2754–2762
Maekawa Y, Kawamura A, Yuasa S, Ohno Y, Arai T, Fukuda K (2013) Acute coronary syndrome or apical ballooning syndrome? Heart Vessel 28:130–133
Ikutomi M, Yamasaki M, Matsusita M, Watari Y, Arashi H, Endo G, Yamaguchi J, Ohnishi S (2014) Takotsubo cardiomyopathy in siblings. Heart Vessel 29:119–122
Dib C, Asirvatham S, Elesber A, Rihal C, Friedman P, Prasad A (2009) Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy). Am Heart J 157:933–938
Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, Califf RM, Wagner GS (1996) Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med 334:481–487
Wittstein IS, Thiemann DR, Lima JAC, Baugham KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352:539–548
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflicts of interest from financial support or sponsors.
Rights and permissions
About this article
Cite this article
Ito, T., Fujita, H., Ichihashi, T. et al. Electrocardiographic changes associated with takotsubo cardiomyopathy in a patient with pre-existing left bundle branch block. Heart Vessels 31, 1393–1396 (2016). https://doi.org/10.1007/s00380-015-0766-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-015-0766-x