ko-tsubo Cardiomyopathy With Apical Variant Complicated Cardiac Tamponade and Mid-Ventricular Variant

Tako-tsubo syndrome is a disease with similar alterations to ose observed in acute myocardial infarctions in the absence of ronary stenosis. Several pathophysiological mechanisms have en proposed to explain the unusual features of this syndrome, ch as multivessel coronary vasospasm, abnormalities in ronary microvascular function, and catecholamine-mediated rdiotoxicity. Inflammation may also play a role, despite the fact at there is little evidence in the medical literature to relate flammation with this syndrome. A 75 year-old woman with asthma and hypertension sought ergency care after an episode of oppressive retrosternal pain at st, pain and symptoms related to the parasympathetic nervous stem and no stress trigger. An electrocardiogram (ECG, Fig. 1) owed 1 mm ST-segment elevation in I, aVL, V1, and V2, and deep mmetrically inverted T waves. A physical examination revealed chypnea with crackles in both lungs. An echocardiogram vealed anteroapical akinesia and moderate systolic dysfunction. on hospitalization, troponin I levels were 0.24 ng/mL (reference lue: up to 0.12 ng/mL), with a peak of 1.74 ng/mL within the first h, and normal creatinine kinase (CK). The coronary angiography d not reveal epicardial coronary lesions. The ventriculogram was nsistent with extensive apical akinesia (Fig. 1). The patient as admitted to the cardiology department, and was started on giotensin-converting enzyme inhibitors and diuretics. After h, a control echocardiogram revealed moderate pericardial fusion, with no signs of haemodynamic instability, and she was ministered non-steroidal anti-inflammatory drugs. A cardiac agnetic resonance imaging (MRI) performed 4 days after