Tako-tsubo syndrome. Atypical presentation.

that had started following an argument. She did not have cardiologic symptoms, except for an ECG with negative T-waves in the lateral aspect and troponin T concentration of 0.06 in the laboratory workup (peak, 0.23). An emergency echocardiogram showed apical akinesia with preserved ejection fraction (Figure). Urgent coronary angiography performed 2 hours later showed a mild lesion in the right coronary artery and no lesions in the left coronary system. Ventriculography revealed midventricular akinesia of the left ventricle and preserved apical contractility. Based on the findings, TTS was diagnosed. The patient progressed favorably with anxiolytic treatment, beta blockers, enoxaparin, and acetylsalicylic acid. At 5 days, echocardiography showed resolution of all abnormalities. Nine months after discharge, the patient remained under acetylsalicylic acid therapy and was free of symptoms and recurrences. TTS was first described in Japan in 1990. It presents as an acute coronary syndrome with no signs of coronary stenosis, and left ventriculography shows the characteristic image for which TTS is named. Since that time, an increasing number of cases that did not fit the initial description REFERENCES 1. Ward DE, Bexton R, Camm AJ. Characteristics of atrio-His conduction in the short PR interval, normal QRS complex syndrome. Evidence for enhanced slow-pathway conduction. Mannens MM, et al. Diagnostic criteria for congenital long QT syndrome in the era of molecular genetics: do we need a scoring system? Eur Heart J. 2007;28:575-80. Tako-tsubo syndrome (TTS) is an emerging condition that has continued to present in new forms since it was first described. A 58-year-old woman with dyslipidemia came to our hospital for angina and vegetative symptoms Figure 1. End-diastolic and end-systolic ventriculography images show apical akinesia.