A 78-year-old woman with no known coronary risk factors was admitted.
Patient was admitted to the emergency department with a 24-hour history of left chest pain that appeared after moderate physical exercise, without apparent emotional stress.
Dyspnea and fatigue were associated.
The initial clinical evaluation was well perfused, with a pulse of 105/min, blood pressure of 98/57 mmHg.
Cardiovascular examination was normal.
Routine tests showed an electrocardiogram that showed ST-segment elevation in the anterior wall (V2-V4) and elevated markers of myocardial damage (troponins 7.10 ng/ml, CK-total 368 U).
An emergency coronary angiography was performed one hour after admission, which revealed an anterior descending artery with a proximal lesion of 30% and slow flow, without the remaining coronary arteries showing significant lesions.
The left ventriculography with contrast showed apical ballooning.
A probable diagnosis of TTS was established and the patient was admitted to the Coronary Care Unit for standard medical treatment of acute coronary syndrome (ACS).
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Echocardiography on the second day of hospitalization showed: 1) LV with biphasic dimensions in normal ranges with extensive ante-oseptoapical and tip septal akinesia; 2) Estimated systolic pulmonary function with moderately depressed systolic ejection fraction of 40%.
On the third day, control leads revealed T wave inversion from V2 to V6.
The subsequent evolution was favorable, with disappearance of pain and decreased markers of myocardial damage, so it was decided to discharge on the ninth day of hospitalization.
One-month follow-up with 2-D echocardiography showed: 1) preserved LV systolic function; 2) mild mitral insufficiency with normal valve appearance.
Myocardial perfusion study was performed with SPECT and scintigraphy to assess ventricular function with Tecnecio99m-SESTAMIBI under stress with Bruce protocol and at rest, concluding global and segmental motility and systolic function.
