CONGRESS ABSTRACT

A 54-year-old female admitted to our Cardiology ICU due to acute abdominal pain radiating to the chest. The ECG showed sinus rhythm and flat T-waves in the infero-lateral leads. A TTE disclosed severe left ventricular dysfunction. Routine blood tests were performed: Troponin I: 1.05 → 1.02 ng/ml (normal reference range: 0–0.034), NT-proBNP: 1100 pg/ml, Hemoglobin: 11.1 g/dl, GOT (AST): 78 U/l (nr 0–36), GPT (ALT): 92 U/l (nr 0–35), GGT: 134 U/l (nr: 0–58). Based on these findings, a diagnosis of NSTEMI was established. Medical history: fibromyalgia, factor V Leiden mutation, microcytic anemia, and traumatic rib fractures two months prior, which led to the extensive use of NSAIDs for pain management. The patient also reported several episodes of epigastric pain accompanied by nausea, loss of appetite, and constipation over the preceding two weeks. She was not on any medications at the time of admission. The patient's vital signs were stable upon admission. A repeat TTE revealed LVEF 30%, with akinesis of the mid-wall segments and hypokinesis of the basal septum and basal anterior wall segments. During the next day, invasive coronary angiography showed no coronary stenosis. Post-procedural ECG findings were consistent with Takotsubo cardiomyopathy, demonstrating diffuse deep T-wave inversions. Two days later, a follow-up TTE revealed near-complete recovery of the LVEF. To confirm the diagnosis, the patient underwent CMR four days after admission. CMR showed normal biventricular ejection fractions, increased native T1 and T2 mapping, apical edema, and no LGE. As a collateral finding, multiple liver lesions were noted. Concurrent investigation of the abdominal pain included: abdominal ultrasound, upper gastrointestinal endoscopy and a total-body CT scan, that showing near the head of the pancreas and at the hepatic hilum, a hypodense mass, multiple loco-regional lymph nodes and multiple secondary lesions throughout all hepatic segments. Final diagnosis: needle biopsy of the liver confirmed liver metastases from biliopancreatic cancer. DISCUSSION: It is now well established that there are multiple connections between cardiovascular disease and cancer due to the interaction of numerous biologically active factors. This phenomenon is known as 'reverse cardio-oncology.' In our case, the question is: is Takotsubo syndrome an incidental diagnosis, or is it linked to cancer progression?