Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in Takotsubo Cardiomyopathy During 15 Years of Follow-Up

Takotsubo cardiomyopathy (TTC) or stress-induced cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. Although the underlying mechanism is still unknown, exaggerated sympathetic nervous system and catecholamine cardiotoxicity, followed by metabolic disturbance, and multi-vessel epicardial coronary artery vasospasm, are thought to be responsible for the development of this condition. TTC accounts for 1-2% of patients presenting with the acute coronary syndrome (ACS) with the majority of patients being postmenopausal women. Shark fin electrocardiogram (SFE) or triangular ST-segment elevation is an uncommon electrocardiogram (ECG) finding that is typically associated with an increased risk of ventricular fibrillation and cardiogenic shock, thus, it is considered a poor prognostic factor. We present a case of a 57-year-old postmenopausal female with TTC post-colonic perforation. Upon further investigation, an ECG revealed an SFE or triangular ST-segment elevation on the anterolateral leads, and an elevated serum troponin level was found. On trans-thoracic echocardiogram (TTE), hypokinesis and akinesis of the apex and left ventricular segments were observed with sparing of the basal segments. Eventually, the patient was successfully managed and monitored until regain of normal function.