Case report Eight-vessel disease mimicking takotsubo cardiomyopathy

A 44-year-old Japanese woman presented with a 5-day history of dry cough, nausea and diarrhea. She also complained of chest pain, and headache for an hour prior to the arrival. Past medical history revealed one abortion but no coronary risk factors. On examination, she was in mild confusion (Glasgow Coma Scale of E4V5M6) and afebrile. The vital signs included the blood pressure of 85/56mmHg, the pulse of 78/min, the respiratory rate of 24/min and the SpO2 of 100% on breathing ambient air. Auscultation of lungs was normal. There were no third and fourth heart sounds. Her abdomen was soft and flat without tenderness. There was no leg edema. An electrocardiogram (ECG) on arrival revealed normal sinus rhythm, ST segment elevations in aVR and aVL, ST segment depressions in II, III, aVF, V3-5, inverted T waves in V1-2 and no Q waves (Figure 1). Chest X-ray film showed no cardiomegaly. Echocardiography showed akinesis in the apical area and hyperkinesis in the basal area of the left ventricle. A tentative diagnosis of acute coronary syndrome (ACS) or takotsubo cardiomyopathy (TC) a few days after onset was provided and thus emergency cardiac catheterization was performed within 90min after her arrival. Coronary angiography