A variant form of acute reversible cardiomyopathy: a case report

We report a case of a woman with transient myocardial injury after a stressful event, presenting with a variation of the affected segments. In this case, only the basal and mid portions of the left ventricle were affected, while the apex was completely spared. Coronary angiography revealed no significant occlusion and left ventricular function had recovered completely by the third day of hospitalization.We present a variant form of stress cardiomyopathy, affecting the basal and mid segments of the left ventricle.Takotsubo cardiomyopathy or left ventricular (LV) apical ballooning consists of acute onset of transient akinesia, affecting the apical and mid portions of the left ventricle, accompanied by reversible, dynamic ST-T segment abnormalities, chest pain and slightly increased cardiac enzymes, without significant coronary artery stenosis. This kind of acute reversible heart injury syndrome has been named after the elective LV apical dysfunction.We report a case comprising the characteristics of stress cardiomyopathy with a variation of the affected LV segments, sparing completely the LV apical segment.A 64-year-old woman with a history of hypertension and hypercholesterolemia under treatment, presented to our emergency department with acute onset of substernal chest pain radiating to the neck and jaw. The pain had emerged 2 hours earlier when she had experienced near-drowning and fear of imminent death.Physical examination on admission revealed a heart rate of 100 bpm, her blood pressure was 150-90 mmHg and her oxygen saturation was 97%. A grade 1–2/6 systolic murmur and a fourth heart sound were heard.ECG demonstrated ST-segment elevation in leads V2–V6. Echocardiographic evaluation depicted decreased LV ejection fraction (40%), with new regional wall motion abnormalities, i.e. hypokinesis of the basal and mid segments of the LV (fig. 1, 2, 3). It was noted that these changes had not been noted on a previous routine echocardiogram. However, subsequent coronary a