Subject(s)
Arteriovenous Malformations/diagnosis , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Angiography , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/therapy , Brain/diagnostic imaging , Brain Infarction/diagnostic imaging , Embolization, Therapeutic , Humans , Male , Middle Aged , Neuroimaging , Pulmonary Artery/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then.
ABSTRACT
BACKGROUND: Reverse Takotsubo cardiomyopathy is one of the rarest types of stress-induced cardiomyopathy, which despite sharing similar pathogenic mechanisms with its more common counterpart, has different clinical manifestations, demographics, and laboratory values. CASE REPORT: We present the case of a 61-year-old woman who came to the hospital with a chief complaint of chest pain and dyspnea. She was found to have elevated troponin and severely depressed left ventricular function. Echocardiography showed normal contracting apex, with the rest of the left ventricle being hypokinetic. Cardiac catheterization revealed mild coronary artery disease and confirmed echocardiographic findings showing hyperkinetic apex and dilated base. She was discharged home on ACE inhibitor and B-blocker. A repeat echocardiogram 2 weeks after the initial presentation showed complete resolution of cardiac dysfunction. CONCLUSIONS: Reverse Takotsubo cardiomyopathy is a rare disease mimicking acute coronary syndrome. It is essential to rule out organic coronary disease prior to attributing the presentation to Takotsubo cardiomyopathy. With supportive care, the long-term prognosis is good in the vast majority of patients.
