J Cardiovasc Ultrasound.  2008 Mar;16(1):29-32. 10.4250/jcu.2008.16.1.29.

A Case of ST-Segment Elevation Myocardial Infarction Mimicking Stress-Induced Cardiomyopathy

Affiliations
  • 1Division of Cardiology, College of Medicine The Catholic University of Korea, Daejeon, Korea. hhhsungho@naver.com

Abstract

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.

Keyword

ST-segment elevation myocardial infarction; Stress-induced cardiomyopathy

MeSH Terms

Cardiomyopathies
Chest Pain
Coronary Angiography
Humans
Myocardial Infarction

Figure

  • Fig. 1 Twelve-lead electrocardiogram revealed mild ST elevation on lead I, aVL and tall T-waves on lead V4, 5 (A). After admission to our hospital, ectrocardiogram showed normalized ST segment and T waves (B).

  • Fig. 2 Echocardiogram obtained upon admission showed hyperkinesis of the basal segments on apical four (A) and two (B) chamber views. A following echocardiogram revealed resolution of the wall motion abnormalities on same views after 2 weeks (C, D). Dotted lines are endomyocardial lines.

  • Fig. 3 In the anterior posterior view, left coronary artery showed severe spastic nature (A) and spasm was resolved after administration of nitrate into the left coronary artery (B). There was a fixed discrete lesion at ostium of left anterior descending artery in the spidal view (C).


Cited by  2 articles

A Case of Acute ST-Segment Elevation Myocardial Infarction Mimicking Stress Induced Cardiomyopathy; Demonstration of Typical Echocardiographic Finding Correlated with Unusual Distribution of Left Anterior Descending Coronary Artery
Sung Kyun Shin, Seon-Ah Jin, Yong Kyu Park, Jae-Hyeong Park
J Cardiovasc Ultrasound. 2010;18(3):101-103.    doi: 10.4250/jcu.2010.18.3.101.

Acute Coronary Syndrome Mimicking Atypical Stress-Induced Cardiomyopathy in a Patient with Panhypopituitarism
Chan Seok Park, Yu-Seon Yun, Yoon Ji Kim, Mi-Jeong Kim, Eun-Joo Cho, Sang-Hyun Ihm, Hae-Ok Jung, Hui-Kyung Jeon, Hee-Yeol Kim, Ho-Joong Youn
J Cardiovasc Ultrasound. 2010;18(1):16-20.    doi: 10.4250/jcu.2010.18.1.16.


Reference

1. Cangella F, Medolla A, De Fazio G, Iuliano C, Curcio N, Salemme L, Mottola G, Agrusta M. Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy. Cardiovasc Ultrasound. 2007. 5:36.
Article
2. Derian W, Soundarraj D, Rosenberg MJ. Stress-induced cardiomyopathy: not always apical ballooning. Rev Cardiovasc Med. 2007. 8:228–233.
3. Sato H, Tateiski H, Uchida T. Kodama K, Haze K, Hon M, editors. Takotsubo type cardiomyopathy due to multivessel spasm. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure (in Japanese). 1990. Tokyo: Kagakuhyouronsya;56–64.
4. Lacy CR, Contrada RJ, Robbins ML, Tannenbaum AK, Moreyra AE, Chelton S, Kostis JB. Coronary vasoconstriction induced by mental stress (simulated public speaking). Am J Cardiol. 1995. 75:503–505.
Article
5. Sharkey SW, Shear W, Hodges M, Herzog CA. Reversible myocardial contraction abnormalities in patients with an acute noncardiac illness. Chest. 1998. 114:98–105.
Article
6. Kurisu S, Sato H, Kawagoe T, Ischihara M, Shimatani Y, Nishioka K, Kono Y, Umemura T, Nakamura S. Takotsubo like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002. 143:448–455.
Article
7. Yang NI, Hung MJ, Cherng WJ. Coronary artery spasm-related acute coronary syndrome in patients with coexisting spasm of angiographically normal coronary artery and fixed narrowing of the remaining vessels. Angiology. 2007. 58:156–160.
Article
8. Romaqnoli E, Lanza GA. Acute myocardial infarction with normal coronary arteries: role of coronary artery spasm and arrhythmic complications. Int J Cardiol. 2007. 117:3–5.
Article
9. Mann DL, Kent RL, Parsons B, Cooper G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation. 1992. 85:790–804.
Article
10. Khallafi H, Chacko V, Varveralis N, Elmi F. "Broken heart syndrome": catecholamine surge or aborted myocardial infarction? J Invasive Cardiol. 2008. 20:E9–E13.
11. Kolettis TM, Baltogiannis GG, Tsalikakis DG, Tzallas AT, Agelaki MG, Fotopoulos A, Fotiadis DI, Kyriakides ZS. Effects of dual endothelin receptor blockade on sympathetic activation and arrhythmogenesis during acute myocardial infarction in rats. Eur J Pharmacol. 2008. 580:241–249.
Article
12. Hassan Y. Job strain and recurrent coronary heart disease events. JAMA. 2008. 299:520.
Article
13. Wilbert-Lampen U, Leistner D, Greven S, Pohl T, Sper S, Völker C, Göthlin D, Plasse A, Knez A, Küchenhoff H, Steinbeck G. Cardiovascular events during World Cup soccer. N Engl J Med. 2008. 358:475–483.
Article
14. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med. 2005. 352:539–548.
Article
15. Chang KY, Jeon HK, Chae JS, Ihm SH, Seung KB, Youn HJ, Baek SH, Kim JH, Hong SJ, Choi KB. A novel cardiomyopathy mimicking acute myocardial infarction. Kor Circ J. 2002. 32:608–612.
Article
16. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic Review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004. 141:858–865.
Article
17. Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K. The clinical features of takotsubo cardiomyopathy. QJM. 2003. 96:563–573.
Article
18. Kim TS, Chu EH, Kang HH, Chun SW, Cho EJ, Kim JH. A Case of Reversal of Takotsubo Cardiomyopathy in Patient with Pheochromocytoma. J Cardiovasc Ultrasound. 2007. 15:50–54.
Article
19. Kim DH, Bang DW, Ahn JH, Park SH, Oh HS, Yoon YJ, Hyon MS, Kim SK, Kwon YJ. Three Cases of Stress Induced Transient LV Dysfunction-Stress Induced Cardiomyopathy. J Kor Soc Echo. 2005. 13:83–86.
Article
20. Chung JW, Kang MJ, Kim YH, Chang JH, Ha SI, Kim HJ, Koh YY, Chang KS, Hong SP. The Clinical Feature of Regional Wall Motion Abnormality on Apex of the Left Ventricle with Normal Coronary Angiogram. J Kor Soc Echo. 2005. 13:74–79.
Article
21. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction. Ann Intern Med. 2004. 141:858–865.
Article
22. Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006. 48:1319–1325.
23. Fragmin and Fast Revascularisation During Instablility in Coronary Artery Disease Investigators. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet. 1999. 354:708–715.
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