Case 2:
A 70-year old healthy Hispanic woman with past medical history significant only for hypertension, presented with new-onset severe retrosternal chest discomfort, that was worse with activity, associated with diaphoresis and shortness of breath, symptoms started about 24 hours prior to presentation. She was seen at her cardiologist’s office, her EKG showed new deep T wave inversions in the precordial leads and subtle ST elevation in the inferior leads (Figure 3). She was sent to the emergency department from the office, her echocardiogram showed severe hypokinesis of the antero-apical wall, confirming anterior myocardial infarction. She tested negative for SARS-CoV-2 and was emergently taken to the cardiac catheterization lab for further evaluation.
Coronary angiography revealed only mild calcification and non-obstructive disease in the coronary arteries with a right dominant circulation (Figure 4). Myocardial bridge was noted in the proximal-mid left anterior descending artery (Figure 4). Further, left ventricular end-diastolic pressure was elevated at 22 mm Hg and left ventriculography showed a severely depressed left ventricular ejection fraction of 30% with antero-apical and infero-apical wall akinesis (Figure 4 and Supplementary videos 1 and 2). Overall, her clinical presentation was hence consistent with Takotsubo cardiomyopathy. She was started on medical therapy with beta-blockers, anxiolytics, and discharged home with close cardiology follow-up.
In retrospect, during our interaction with the patient, she endorsed significant stress during the past few weeks, due to ongoing health issues. She had noticed a gradual decline in her visual acuity, however, due to the ongoing pandemic and outpatient appointment restrictions due to that, she was not able to schedule an ophthalmology appointment, despite repeated attempts, further adding to her stress.