Estrés emocional relacionado con un terremoto como factor causante de un síndrome de takotsubo / Takotsubo syndrome associated with an earthquake. report of two cases

Takotsubo syndrome is an acute heart disease usually triggered by significant emotional or physical stress, very occasionally described in association with natural disasters such as earthquakes. Clinically, it simulates an acute myocardial infarction with similar symptoms, laboratory tests, and electrocardiographic changes. Coronary angiography shows the absence of significant coronary disease. We report two women, aged 71 and 80 years, and who developed a Takotsubo syndrome after an earthquake. In both, the syndrome was diagnosed with cardiac magnetic resonance imaging.

El rol de la resonancia magnética cardíaca en el diagnóstico diferencial entre miocarditis aguda e infarto agudo de miocardio con elevación del segmento ST / Cardiac magnetic resonance imaging for the diagnosis of acute myocarditis mimicking a myocardial infarction

BACKGROUND: Acute myocarditis frequently mimics an acute myocardial infarction, and its diagnosis is a clinical challenge. AIM: To describe the characteristics of cardiac magnetic resonance imaging in patients with acute myocarditis hospitalized with a diagnosis of ST-segment elevation myocardial infarction. PATIENTS AND METHODS: Twenty-four patients aged 33 ± 11 years (21 men) with a definitive diagnosis of acute myocarditis hospitalized with a presumptive diagnosis of ST-segment elevation myocardial infarction, in whom a coronary angiogram excluded significant atherosclerotic coronary lesions, were included. Cardiac magnetic resonance imaging with cine-resonance images was performed to assess global and regional ventricular function, and to study myocardial tissue characteristics. T2-STIR sequences were used for the assessment of oedema and late gadolinium enhancement for necrosis/fibrosis. RESULTS: Patients had high levels of total CK, CK-MB, troponin I, brain natriuretic peptide and C-reactive protein. Cardiac magnetic resonance imaging revealed myocardial edema and late gadolinium enhancement was identified in all patients. The edema was transmural in 86% and subepicardial in 14%. Enhancement was subepicardial in 74% of patients and intramural in 26%. It was located in the inferior and lateral walls of the left ventricle in 93%, without affecting the endocardium. In all patients, two of three Lake Louise criteria were met, and an acute myocarditis was diagnosed. CONCLUSIONS: Cardiac magnetic resonance imaging is the diagnostic method of choice for diagnosing acute myocarditis when it mimics an acute myocardial infarction.

Valor de la resonancia magnética cardíaca para el diagnóstico diferencial en pacientes con sospecha de infarto agudo de miocardio con elevación del segmento ST y arterias coronarias normales

Background: Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it. Aim: To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs. Material and Methods: We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded. Results: Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE. Conclusions: Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.