Transient Left Ventricular Outflow Obstruction in Tako Tsubo- Syndrome: A Case Report

This is a clinical case of an 83-years-old woman referred to our hospital for the occurrence of chest pain and syncope, related to an intense emotional stress in the previous three months and an before the acute coronary syndrome. At admission, the electrocardiogram showed S-T segment elevation from V1-V3 and deep inversion of the T-wave in V4-V6, and an increase in troponin I level (6.4 ng/mL). Echocardiogram showed midapical segment akinesia with left ventricular dysfunction. Basal segments were hypercontractile and there was evidence of left ventricular outflow tract (LVOT) obstruction with an end-systolic peak gradient of 99 mmHg. Regression of the LVOT obstruction was detected at third day. Three weeks after admission a serial two-dimensional echocardiography and nuclear medicine studies showed a complete regression of the left ventricular wall motion abnormalities with an improvement of systolic function.