[A rare complication of takotsubo cardiomyopathy].

HISTORY AND ADMISSION FINDINGS

A 70-year old woman was admitted by the emergency doctor directly to our cardiac catheterization unit with persisting chest pain 60 minutes after onset of symptoms. Except for hypertension and hypercholesterinemia there was no cardiac history. On examination we found a bradykardia of 43/minutes, no other pathological signs.

DIAGNOSTIC PROCEDURES

The ECG showed significant ST-segment elevation in I, aVL, V4-V6, and revealed a complete dissociation between p-wave and QRS-complex. This led to the diagnose of a ST-elevation myocardial infarction of the lateral wall connected with a third degree AV-block.

TREATMENT AND COURSE

First a transvenous pacing was done and the subsequent coronary angiography excluded coronary vascular disease. The laevocardiography showed an apical ballooning, therefore takotsubo cardiomyopathy could be diagnosed. Due to persisting third degree AV-Block, a permanent pacemaker was implanted on the fourth day of treatment. After one week the left ventricular function was nearly normal. The intravascular ultrasound excluded a ruptured plaque.

CONCLUSION

In patients presenting acute coronary syndrom and apical ballooning, takotsubo cardiomyopathy should be considered after excluding coronary vascular disease. We presented a rare case of takotsubo cardiomyopathy together with a third degree AV-block. In spite of its persistence and the need of a permanent pacemaker implantation, the prognosis of the disease remained good.