52 years old female patient with history of hypertension was admitted to emergency department due to severe chest pain after her husbands death. Electrocardiography showed ST segment elevation in anterior leads. Echocardiography demonstrated anterior wall hypokinesia. Therefore she underwent coronary angiography (CAG ) immediately . No significant coronary artery stenosis was detected in the CAG. However, the ventriculography showed anterobasal and posterobasal akinesis with preserved anteroapical and posteroapical function with an ejection fraction (EF ) of 35-40%. She was discharged five days later with prescription of aspirin, clopidogrel, bisoprolol, ramipril and sprinolactone therapy. Her echocardiography showed improving left ventricular systolic function with complete resolution of the regional wall motion abnormalities in the first month. Takotsubo cardiomyopathy ( TTC ), also known as broken heart syndrome, is a cardiomyopathy seen in the setting of acute illness or emotional or physical stress.Typical TTC was known that apical ballooning syndrome. The incidence of TTC is estimated to be approximately 2% of all acute coronary syndromes(ACS). There are different variants of TTC.Typical TTC was characterized with apical involvement ,however, as in this case, reverse-TTP involved basal segment of left ventricle .The majority of typical TTC cases are women of postmenapausal age while patients with reverse TTC are at a younger age and this patients have better EF compare with typical TTC. Reverse- TTC should be considered in the differential diagnosis of ACS in patients with non significant coronary artery stenosis and non-apical hypokinesia.
Anahtar Kelimeler: Cardiomyopathy, takotsubo, reverse-takotsubo,myocardial infarction,stress.