# 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.

## Key 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.