CASE PRESENTATION: A 38-year-old healthy American woman with negative past medical history presented to our Emergency Department with
chest pain developing while participating in intense outdoor physical activities (Zumba) at a fundraising event. Our patient had typical substernal
chest pain induced with exercise and was relieved by sublingual
nitroglycerin in the Emergency Department. The
pain started after 2 h of intensive Zumba workout. On review of her history, our patient was noted to be taking
spironolactone 125 mg once daily for
hirsutism for the past year. Our patient denied any family history of
cardiac disease or
heart failure. She admitted to being a former occasional smoker and to drinking alcohol socially. She denied any
illicit drug use. She works as a social worker, and reported that she does not experience much stress in her life and denied any "one big life-changing event" or any major stressful news. While in the Emergency Department, our patient was hemodynamically stable and an electrocardiography was performed and showed sinus rhythm with no ST elevation/depression but noted T-wave inversion in leads I and aVL, and T wave flattening in leads V1 and V2. Her
troponin levels were 0.294 and 0.231 consecutively. An echocardiogram was done and showed hypokinetic apical and mid-distal walls and hyperdynamic basal walls of the left ventricle with an ejection fraction of 35-40%, consistent with
apical ballooning syndrome. Cardiac catheterization was subsequently done and showed depressed left ventricle systolic function, ejection fraction of 30-35% with anteroapical
dyskinesia and no evidence of
coronary artery disease. Our patient was diagnosed with
Takotsubo cardiomyopathy after fulfilling all four of the Mayo Clinic's diagnostic criteria and was subsequently treated with a beta blocker, and
angiotensin-converting enzyme inhibitor.
CONCLUSIONS: