A Case of Acute ST-Segment Elevation Myocardial Infarction Mimicking Stress Induced Cardiomyopathy; Demonstration of Typical Echocardiographic Finding Correlated with Unusual Distribution of Left Anterior Descending Coronary Artery

Abstract

Stress-induced cardiomyopathy (SCMP) is diagnosed in 1-2% of patients presenting with symptoms suggestive of acute coronary syndrome. Because of sharing many common clinical features with SCMP, acute ST-segment elevation myocardial infarction (STEMI) can be misdiagnosed as SCMP. However, it can be associated with fatal outcome of the patient. Also, diagnosis of SCMP seems to be always challenging to clinicians, especially in the decision of taking coronary angiography which is still invasive and even risky. Here, we present a case with acute STEMI mimicking SCMP as a result of anatomical variation of coronary circulation. In this patient, prompt and early coronary angiography and stent implantation was very helpful.

Stress Cardiomyopathy Complicated by Left Ventricular Thrombi and Cerebral Infarctions in a Patient with Essential Thrombocythemia

“…Catecholamine-mediated multivessel epicardial or microvascular coronary vasospasm or direct catecholamine-mediated myocyte injury has been proposed as possible pathophysiological mechanisms 1). Because clinical characteristics of SCMP are quite similar to those of AMI, the differential diagnosis between SCMP and AMI is very difficult and usually requires coronary angiography 2). Coronary angiography was also performed in the present case to rule out AMI as a cause of LV dysfunction and revealed normal coronary circulation.…”

“… 1) Because clinical characteristics of SCMP are quite similar to those of AMI, the differential diagnosis between SCMP and AMI is very difficult and usually requires coronary angiography. 2) Coronary angiography was also performed in the present case to rule out AMI as a cause of LV dysfunction and revealed normal coronary circulation. Provocation test for vasospasm was not performed, because vasoactive drugs including intravenous nitrates were prescribed already.…”

Role of Imaging in the Detection of Reversible Cardiomyopathy

“…However, SCMP can be misdiagnosed as AMI, and AMI can be misdiagnosed as SCMP 42). The recent guidelines for the diagnosis of SCMP37) define this entity on the basis of acute LV apical ballooning, after exclusion of AMI.…”