CONGRESS ABSTRACT

Takotsubo Syndrome (TTS) is an acute, reversible form of non-ischemic cardiomyopathy characterized by transient left ventricular systolic dysfunction that mimics acute coronary syndrome without obstructive coronary artery disease. It is typically triggered by intense emotional or physical stress, resulting in catecholamine-mediated myocardial stunning. TTS commonly presents with acute chest pain, electrocardiographic abnormalities, and modest elevation of cardiac biomarkers. While the prognosis is generally favorable, the condition can lead to significant acute complications and long-term morbidity. The involvement of male patients, especially in advanced age, remains underreported. We describe an unusual case of TTS in an 86-year-old man who presented to the Emergency Department with acute chest pain radiating to the left arm, lasting for two days. No recent emotional stressors or other physical triggers were reported, except for the sudden onset of severe chest pain itself. The patient had a history of chronic ischemic heart disease (previous PTCA with DES placement in the RCA and proximal–mid LAD). Admission ECG showed a known right bundle branch block, mild ST-segment elevation in the inferior leads (II, III, aVF), reciprocal ST-segment depression in lateral leads (I and aVL), and ST-segment depression in precordial leads V2–V3. High-sensitivity troponin was mildly elevated (43 ng/L). Coronary angiography revealed a moderate (50–60%) stenosis of the LAD proximal to the stent and mild in-stent restenosis, findings that did not fully account for the ECG changes.Transthoracic echocardiography demonstrated right ventricular apical akinesia and left ventricular apical hypokinesia, with basal hypercontractility and a markedly reduced ejection fraction, findings absent on previous examinations. On the following day, deep, diffuse T-wave inversions in all precordial and peripheral leads and marked QTc prolongation (640 ms) were recorded. Based on the combination of ECG abnormalities, echocardiographic wall motion defects, and modest troponin elevation, a diagnosis of biventricular Takotsubo syndrome was established, likely triggered by coronary vasospasm. This case illustrates an atypical presentation of Takotsubo syndrome in an elderly male patient with biventricular involvement and absence of classical emotional triggers. It underscores the importance of considering TTS in diverse populations and highlights the disease’s wide clinical spectrum.