Takotsubo: A STEMI Mimic

Takotsubo cardiomyopathy (TCM), also referred to as stress-induced cardiomyopathy or "broken heart syndrome," is a transient and reversible cardiac dysfunction that closely mimics acute coronary syndrome (ACS) but occurs in the absence of obstructive coronary artery disease. First identified in Japan in the early 1990s, the condition derives its name from the Japanese word Takotsubo, referring to an octopus-trapping pot, which resembles the characteristic apical ballooning of the left ventricle seen on echocardiography.

The syndrome predominantly affects postmenopausal women and is often precipitated by acute emotional or physical stress. While the exact pathophysiology remains under investigation, excessive catecholamine release is believed to play a central role, leading to myocardial stunning, transient left ventricular systolic dysfunction, and regional wall motion abnormalities. Unlike true myocardial infarction, TCM does not involve acute plaque rupture or coronary thrombosis.

This paper presents a case study of an 82-year-old female who was admitted with severe chest pain and electrocardiographic (ECG) changes suggestive of ST-elevation myocardial infarction (STEMI). Despite significant ECG findings and an elevated troponin level, coronary angiography revealed non-obstructive coronary artery disease, ultimately leading to a diagnosis of Takotsubo cardiomyopathy. The case highlights the importance of recognizing TCM as a differential diagnosis in patients presenting with ACS-like symptoms, especially in high-risk populations such as elderly women experiencing significant emotional or physical stress.

The discussion explores the diagnostic criteria required to distinguish TCM from acute myocardial infarction, including the Mayo Clinic criteria, ECG patterns, cardiac biomarkers, and imaging modalities such as echocardiography and cardiac magnetic resonance imaging. Furthermore, the pathophysiological mechanisms underlying TCM are examined, focusing on the role of sympathetic overstimulation, endothelial dysfunction, and microvascular dysfunction.

Despite its generally favorable prognosis, Takotsubo cardiomyopathy is not entirely benign. There is a 1–2% annual recurrence rate, and inpatient mortality can be as high as 4%, particularly in cases complicated by cardiogenic shock, arrhythmias, or left ventricular outflow tract obstruction. Management primarily involves supportive therapy, with beta-blockers, ACE inhibitors, and stress reduction strategies playing a crucial role in long-term care.

This article underscores the need for increased awareness and understanding of Takotsubo cardiomyopathy to ensure accurate diagnosis, appropriate management, and long-term follow-up to prevent recurrence and associated complications.