Case Report: Stepwise noninvasive diagnosis of Takotsubo cardiomyopathy in an elderly patient–From ECG clues to echocardiographic and CTA confirmation

TL;DR

This case report shows how ECG, echocardiography, and CTA can noninvasively diagnose Takotsubo cardiomyopathy in an elderly patient.

Contribution

Demonstrates a stepwise noninvasive diagnostic approach for Takotsubo cardiomyopathy using ECG and imaging.

Findings

ECG showed ST-segment elevations in anterior and inferior leads, suggesting apical injury consistent with TTC.

Echocardiography revealed apical akinesis with preserved basal contraction, and CCTA ruled out obstructive coronary disease.

The patient's LVEF recovered to 61% at 1-year follow-up with normalized ECG.

Abstract

Takotsubo cardiomyopathy (TTC) is frequently misdiagnosed as acute coronary syndrome in elderly patients. This case demonstrates how ECG findings facilitate a noninvasive diagnostic algorithm for TTC, validated by echocardiography and coronary computed tomography angiography (CCTA).

An 88-year-old woman presented with chest tightness and dyspnea after emotional stress (bereavement). Initial ECGs showed the concurrent appearance of ST-segment elevations in anterior (V3-V5) and inferior leads (II, III, aVF), suggesting apical injury and the diagnosis of TTC. Bedside echocardiography revealed apical akinesis with preserved basal contraction (LVEF 35%), while CCTA ruled out obstructive disease. Supportive therapy led to symptom resolution. At 1-year follow-up, LVEF recovered to 61% with normalized ECG.

This case highlights ECG's pivotal role in suspecting TTC, enabling a Noninvasive diagnostic approach (echocardiography + CCTA) for elderly patients.

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