Gaddameedi Sai Rakshith, Thapa Milan, Arty Fnu, Atreya Suryansh, Ravilla Jayasree, Panchal Pratik, Du Doantrang
Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA.
Cardiology, Rutgers Health/Monmouth Medical Center, Long Branch, USA.
Cureus. 2024 Jun 24;16(6):e63028. doi: 10.7759/cureus.63028. eCollection 2024 Jun.
Takotsubo cardiomyopathy (TC) mimics myocardial infarction with symptoms like chest pain, electrocardiogram (EKG) changes, and elevated troponin levels, although it typically features normal coronary arteries upon angiography. While often asymptomatic, coronary artery anomalies (CAAs) can cause intermittent vasospasm and endothelial dysfunction, potentially inducing TC. We report the case of a 74-year-old female with a history of hypertension, hyperlipidemia, and peripheral artery disease, who presented with sudden onset chest pain. Initial EKG and elevated troponin suggested myocardial infarction. However, coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary artery (RCA), with no significant stenosis. Subsequent transthoracic echocardiography indicated TC, with the left ventricular ejection fraction improving from 35-40% to 60-65% within days. Cardiac computed tomography angiography (CCTA) revealed that the anomalous LMCA originated from the common trunk at the right sinus of Valsalva (RSV), which further continued as a large, dominant RCA. The LMCA branched into a small to moderate left anterior descending artery (LAD) and a non-dominant left circumflex artery (LCx). The LMCA followed a prepulmonic/anterior course, while the LCx took an interarterial course between the aorta and pulmonary artery. The patient was referred for further surgical evaluation. We conclude that the CAA was an incidental finding and was not related to underlying TC. Although rare, this case suggests a possible correlation between CAAs and a predisposition to stress-induced cardiomyopathy, warranting further investigation.
应激性心肌病（TC）可模拟心肌梗死，出现胸痛、心电图（EKG）改变及肌钙蛋白水平升高等症状，尽管其血管造影通常显示冠状动脉正常。冠状动脉异常（CAA）虽常无症状，但可引起间歇性血管痉挛和内皮功能障碍，有可能诱发TC。我们报告一例74岁女性病例，该患者有高血压、高脂血症和外周动脉疾病史，突发胸痛。初始心电图及肌钙蛋白升高提示心肌梗死。然而，冠状动脉造影显示左主干冠状动脉（LMCA）起源于右冠状动脉（RCA），无明显狭窄。随后经胸超声心动图显示为TC，数天内左心室射血分数从35%-40%提高到60%-65%。心脏计算机断层扫描血管造影（CCTA）显示，异常的LMCA起源于主动脉窦（RSV）右侧的共同主干，该主干进一步延续为粗大的优势RCA。LMCA分支为细小至中等大小的左前降支动脉（LAD）和非优势左旋支动脉（LCx）。LMCA走行于肺门前/前方路径，而LCx走行于主动脉和肺动脉之间的动脉间路径。该患者被转诊进行进一步的手术评估。我们得出结论，CAA是一个偶然发现，与潜在的TC无关。尽管罕见，但该病例提示CAA与应激性心肌病易感性之间可能存在关联，值得进一步研究。
