# Usefulness of a Left Ventriculogram in Patients Presenting With Acute Coronary Syndrome Due to Takotsubo Cardiomyopathy: A Case Series

## TL;DR

A left ventriculogram helps diagnose Takotsubo cardiomyopathy in patients with acute chest pain and no coronary blockage.

## Contribution

Demonstrates the usefulness of left ventriculogram in diagnosing Takotsubo cardiomyopathy during coronary angiography.

## Key findings

- Left ventriculogram showed classical apical ballooning in most patients with Takotsubo cardiomyopathy.
- All six patients had chest pain and ECG changes mimicking acute coronary syndrome but no obstructive coronary lesions.
- Cardiac magnetic resonance imaging confirmed the diagnosis of Takotsubo cardiomyopathy in most cases.

## Abstract

Introduction: Takotsubo cardiomyopathy (TCM) is an acute and reversible cardiac condition in response to stress, characterised by apical ballooning of the left ventricle (LV) in the absence of coronary artery obstruction. Although the exact pathophysiology remains unclear, it is believed to be triggered by an endogenous surge of catecholamines in response to physiological or emotional stress. TCM patients generally experience a good recovery, and LV function typically recovers within two to three months in most patients.

Methodology: We present a case series of six patients who presented with chest pains and electrocardiographic (ECG) changes consistent with acute myocardial infarction (AMI). The selection criteria were patients presenting with chest pain, raised troponin I, and ECG changes suggestive of acute coronary syndrome (ACS).

Results: These patients ranged in age from their mid-50s to their mid-80s. All these patients presented with chest pain triggered by various activities, including watching a scary movie, adrenaline injection for anaphylaxis following consumption of pistachios, and the patient arguing with neighbours. All these patients underwent coronary angiograms that did not reveal any obvious culprit obstructive lesions, and a left ventriculogram (LVG) was performed in all six patients, demonstrating features of TCM. Most patients had cardiac magnetic resonance imaging (CMRI) as an outpatient, confirming the diagnosis of TCM. LVG showed classical apical ballooning in most patients presenting with TCM.

Conclusion: LVG can help diagnose TCM in patients with poor acoustic windows. This can be easily performed during coronary angioplasty in patients presenting with chest pain and suspected ACS.