Apical Ballooning of Takotsubo Cardiomyopathy in a Patient with Non-ST Elevation Myocardial Infarction Due to Right Coronary Artery Stenosis: The Trapped Octopus Got a Heart Attack

Takotsubo cardiomyopathy (TCM) is characterized by apical ballooning with basal preservation in the absence of obstructive coronary artery disease (CAD) that can otherwise explain wall motion abnormalities. However, there is increasing evidence that acute coronary syndromes (ACSs) may coexist with TCM. This report describes a 61-year-old man with a previous medical history of hypertension, diabetes mellitus, and hyperlipidemia, who presented with acute chest pain and associated shortness of breath. He was diagnosed with a non-ST segment myocardial infarction. Echocardiography revealed impaired systolic function with evidence of apical and periapical ballooning of the left ventricle, characteristic of TCM. Coronary angiography revealed evidence of significant luminal stenosis of the right coronary artery (RCA), necessitating intervention with a drug-eluting stent. This patient demonstrated wall motion abnormalities characteristic of TCM beyond the territory of the affected coronary artery suggesting that CAD and TCM can coexist.