SHM Converge Scientific Abstract ePoster Gallery-Double Whammy: Simultaneous Double Vessel Occlusive Thrombi Due to Takotsubo Myopathy

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This case report describes a 63-year-old woman with chest pain, markedly elevated troponin, and ST-segment elevations who was found on cardiac catheterization to have simultaneous thrombotic occlusions in two coronary vessels: the left anterior descending artery and the first obtuse marginal branch of the left circumflex artery. Her left ventricular ejection fraction was initially reduced to 30–39%, but improved rapidly to 55% the next day. Workup was negative for pheochromocytoma, and no PFO, left atrial appendage thrombus, or atrial fibrillation was found.<br /><br />The authors believe Takotsubo cardiomyopathy (stress-induced cardiomyopathy) precipitated the thrombus formation and distal embolization, making this an unusual presentation because Takotsubo typically occurs without obstructive coronary disease. The patient had risk factors including postmenopausal status, hypertension, hyperlipidemia, tobacco use, and a history of breast cancer in remission.<br /><br />The report highlights that Takotsubo cardiomyopathy can present with ECG changes, elevated cardiac biomarkers, and transient regional wall motion abnormalities, usually in the setting of physical or emotional stress and without myocarditis or pheochromocytoma. Although coronary artery disease can coexist in some cases, simultaneous embolic occlusion of two vessels without a clear embolic source is rare.<br /><br />The rapid normalization of ejection fraction strongly supported the diagnosis of Takotsubo cardiomyopathy rather than ischemic cardiomyopathy from fixed coronary obstruction. The patient improved after balloon angioplasty and was discharged with cardiology follow-up.<br /><br />Overall, the authors emphasize that hospitalists and cardiologists should consider Takotsubo cardiomyopathy even in patients with occlusive coronary disease, especially when ventricular dysfunction resolves quickly and no alternative embolic source is identified.

Asset Subtitle

Aanchal Tyagi

Meta Tag

Author List Aanchal Tyagi, Balaji Pratap, Ivan Kharchenko, Priyanka Bhandari, Raja Varma, Sharnjyot Wander, Waqas Khan

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Transient Left Ventricular Wall Motion Abnormality

Concept Alternative Cause Exclusion

Concept EKG Changes

Concept Troponin Elevation

Distinguished Non-Finalist

Presenter Organization NYU Langone Hospital -- Suffolk

Presenting Author Aanchal Tyagi

Track Adult

Keywords

Takotsubo cardiomyopathy

stress-induced cardiomyopathy

coronary thrombosis

myocardial infarction

ST-segment elevation

troponin elevation

left anterior descending artery

obtuse marginal branch

ejection fraction recovery

cardiac catheterization

Takotsubo Cardiomyopathy

Transient Left Ventricular Wall Motion Abnormality

Alternative Cause Exclusion

EKG Changes

Troponin Elevation