It usually affects postmenopausal women between ages 58–75.2 Clinical features of this syndrome mimic those of an acute coronary syndrome, namely chest pain, dyspnea, ST-T changes with or without a prolonged

QT interval, and mild elevations of cardiac enzymes.2-4 On angiography patients will have normal-appearing coronary arteries. Left ventriculogram will show wall motion abnormalities, which is the Inhibitors,research,lifescience,medical basis in defining the different variants. 2 Case Report We report a case of a 64-year-old Hispanic female with a significant past medical history of hypertension, hyperlipidemia, depression, and gastroesophageal reflux disease who presented to the emergency room with intermittent substernal chest pain that began about an hour after having an argument with her son. Troponin was 7.69 and creatine kinase-MB was 39.7 on admission. Electrocardiography (EKG) showed ST-segment elevations in leads Inhibitors,research,lifescience,medical II, III, aVF, V5, and V6 that were consistent with acute ischemia (Figure 1). Her

coronary angiogram revealed normal coronary arteries. Left ventriculogram showed hypokinesis of the midventricular section with a hyperdynamic base and apex (Figures ​(Figures22 and ​and3).3). Cardiac magnetic resonance imaging showed mild hypokinesis of the midinferior and lateral walls and a left ventricular ejection fraction of 70%. The following Inhibitors,research,lifescience,medical day, the patient also had a prolonged QTc of 478 ms, which is commonly seen in patients with nonapical TC.5 The patient was treated with an aspirin, statin, beta blocker, and angiotensin converting enzyme inhibitor. The next day, the patient had sinus bradycardia that was probably secondary to the beta blocker. By day two the patient improved clinically and the acute ischemic changes on EKG had resolved (Figure 4). Figure 1 EKG on initial Inhibitors,research,lifescience,medical presentation. ST-segment elevations in leads II, III, aVF, V5, and V6. QTc is prolonged (478 ms). Figure 2 Left ventriculogram during systole. Figure 3 Left ventriculogram during diastole. Figure 4 EKG on day 2 of admission. ST-segment elevations resolved. QTc Inhibitors,research,lifescience,medical interval is 443 ms. Discussion

Typical and Atypical Takotsubo Cardiomyopathy Typical or classic TC is much more common than the atypical Resminostat variants. It is characterized by transient apical hypokinesis and basal hyperkinesis.3, 4 Several variants of TC have been described. In reverse or inverted TC, the apex is hyperdynamic and the base is akinetic.6 The midventricular type is characterized by akinesis with or without ballooning of the midventricular segment and a hyperdynamic base and apex.7-11 Akinesis of other LV and RV segments have also been described.3, 12 Patients may also have repeated episodes of TC manifesting in the classic and atypical forms.11, 13, 14 Pathophysiology Although the pathophysiology of TC is still not well established, a few theories have been proposed. selleck chemical Emotional or physical stress is considered to be a trigger.