Tako-Tsubo-Kardiomyopathie: eine Differenzialdiagnose beim akuten Koronarsyndrom

ANAMNESIS: A 68-year-old woman was admitted to the emergency unit with symptoms of an acute coronary syndrome. She complained about a feeling of chest oppression for two hours. The cardiac history was unremarkable. Her husband had died few hours before the onset of her cardiac symptoms. INVESTIGATIONS: Blood pressure was 80/40 mmHg, heart rate 110/min. Cardiac enzymes were normal. The ECG showed significant ST elevation in V2 to V6. Laevoangiocardiography revealed a severe reduction of left ventricular systolic function with an ejection fraction of 27 %. Akinesia was seen in the anterior wall region as well as apical, inferior, and poserolateral. Coronary heart disease could be excluded. DIAGNOSIS, THERAPY AND COURSE: Hemodynamic support with catecholamines was needed for one day. After two days hemodynamic recovery occurred. The creatine kinase peak level was surprisingly low (357 U/l). Echocardiographies performed in short intervals showed a continuous, rapid recovery of the ventricular function. Two weeks later the left ventricular function was normal. There was no evidence of myocarditis. In consideration of the history of emotional stress, absence of coronary lesions, a low CK peak and rapid recovery of left ventricular function, Tako-Tsubo cardiomyopathy was diagnosed. Medical treatment with beta blockers was initiated: the further clinical course was unremarkable. CONCLUSION: Tako-Tsubo cardiomypathy should be considered in patients with findings and symptoms of an acute coronary syndrome.