A case of Takotsubo cardiomyopathy in our hospital and a review of the literature

Abstract

The subject was a man in his 70s. In May 20XX, he visited our hospital for hyperlipidemia, hypertension, and diabetes mellitus. 6 months earlier, when he fell down at home, he hit his chest hard on a chair and complained of persistent chest pain for a while. An electrocardiogram, chest X-ray, echocardiography, and blood-centered muscle markers (cardiac troponin I, CPK, and CK-MB) were performed to be sure. Electrocardiography showed negative T waves in limb-guided I, II, III, and aV_F and positive T waves in aV_R, negative T waves in chest-guided V3 to V6, and slight ST depression in V4 and V5. Electrocardiographic findings suggested takotsubo cardiomyopathy, but echocardiography showed thickening of the left ventricular posterior wall and sigmoid septum, with no evidence of wall motion abnormality. Chest X-ray showed a cardiothoracic ratio of 56%, with no evidence of pulmonary congestion, pleural effusion, or fracture, and blood tests showed no abnormalities. An electrocardiogram 1 year and 7 months later showed no Q wave or R wave increase, a positive chest-guided T wave, and ST-segment depression had returned to normal. Since coronary angiography and other tests had not been performed, the possibility of traumatic myocardial injury could not be ruled out, but takotsubo cardiomyopathy was considered as a disease showing similar findings. Although we were unable to provide evidence to link this case to the chest contusion caused by the fall, an abnormal electrocardiogram due to takotsubo cardiomyopathy that developed asymptomatically was the most likely cause of this case.