Takotsubo Syndrome Triggered by Acute Coronary Syndrome in a Cohort of 20 Patients: An often Missed Diagnosis

Background: In spite of being a major stress factor, acute coronary syndrome (ACS) is still regarded as an exclusion criterion for takotsubo syndrome (TS). The aim of the study is to find out an association between ACS, post-ischemic myocardial stunning (PIMS) and TS. Methods: A series of twenty patients with ACS having an acute coronary culprit lesion on coronary angiography and signs of left ventricular dysfunction, which extended beyond the supply region of the diseased coronary artery were studied. Results: Thirteen (65%) out of the 20 patients were women. Ages ranged from 37 to 85 years old. All patients had signs consistent with PIMS. The extent of the stunned myocardium in all patients went beyond the supply region of the diseased coronary artery. The left ventricular myocardial stunning had also a peculiar ballooning appearance during systole, a clinical picture and course also consistent with TS. In all patients, there was no evidence of any emotional or physical stress factor apart from the ACS event. Conclusions: PIMS induced by ACS had typical feature of TS suggesting that PIMS and TS may be two (among other) different names for the same acute cardiac clinical condition. ACS may trigger rather than exclude TS.