Letter to the Editor

Unique Mechanism for Tako-Tsubo Syndrome in an Adult Male

Authors: Awais A. Sheikh, MD, Mohammed H. Usman, MD, Manoj Nepal, MD, Arif Shaik, MD, Mohammad Alauddin, MD, Ajay Kumar, MD, Ali Akbar, MD, Abul Arifuddowla, MD, Martin O'Riordan, MD, FACC

Abstract

To the Editor:


A 49-year-old male with a history of coronary artery disease, lung cancer with left pneumonectomy, chemotherapy and radiotherapy, presented with acute dyspnea and chest pain after straining during defecation. Troponin-T was 0.09 ng/mL (N: 0.00–0.04 ng/mL). He was diagnosed with acute coronary syndrome (ACS) and received aspirin and enoxaparin. His dyspnea improved with albuterol and ipratropium nebulization, but after straining and defecating again in the ER, he went into respiratory distress and was intubated. His chest x-ray showed increased bronchovascular markings with patchy infiltrate in the right lower lobe and opacity in the left lobe (consistent with pneumonectomy). White blood cell count was 12,300/mL. Antibiotics were started for pneumonia. Initial electrocardiogram (ECG) showed sinus tachycardia and subsequently showed precordial ST elevation and QTc prolongation. Troponin-T increased to 0.15 ng/mL (N: 0.00–0.04 ng/mL). Bedside echocardiography revealed large apical akinesia with normal wall thickness. Same-day cardiac catheterization showed diffuse coronary tortuosity, but no obstruction, and left ventriculogram showed akinesia of the apex with basal contraction consistent with Tako-tsubo syndrome.

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