Thanks to Dr Madias for his instructive comments
Could takotsubo syndrome trigger type I myocardial infarction?.
entitled “could takotsubo syndrome (TS) trigger type 1 myocardial infarction” on
our recently published report in the American Journal of Cardiology
entitled “A missed penalty kick triggered coronary death in the husband and broken
heart syndrome in the wife.”
- Y-Hassan S.
- Feldt K.
- Stalberg M.
A missed penalty kick triggered coronary death in the husband and broken heart syndrome
in the wife.
I greatly appreciated Dr Madias awareness of another case, which we regrettably have
unnoticed, of TS in an 82-year-old Italian woman watching a football game where the
results frustrated and angered the patient who blamed for the loss the Italian national
team coach, Marcello Lippi. Kim et al
reported that case as “Lippi-induced cardiomyopathy.” Dr Madias has in addition raised
an interesting hypothesis, which is whether the acute myocardial infarction in our
patient's husband triggered by the stressful football game followed by a fierce argument
has been facilitated by initial TS. Madias proposed that “the disrupted systolic motion
of the left ventricular myocardium, with normokinetic/hyperkinetic myocardial territories
abutting akinetic myocardial regions, could have led to a rupture of a coronary plaque
in the left anterior descending coronary artery and coronary thrombotic occlusion
resulting in acute myocardial infarction.” Because of the patient's critical clinical
condition, left ventriculography was not performed during coronary angiography and
angioplasty. Nevertheless, echocardiography 13 hours and 2 days after the angioplasty
revealed hyopkinesia in the anterior, septal, and apical segments; the contractions
in the inferior and lateral wall were normal. Consequently, the left ventricular wall
motion abnormality pattern was not consistent with TS in that patient. However, the
hypothesis proposed by Madias is appealing and warrants further research. On the other
hand, there is evidence and reports that acute coronary syndrome including spontaneous
coronary artery dissection (SCAD) may trigger TS. We have recently reported on a series
of 20 patients with acute coronary syndrome having left ventricular wall motion abnormality
pattern consistent with TS.
Takotsubo syndrome triggered by acute coronary syndrome in a cohort of 20 patients:
an often missed diagnosis.
Postischemic myocardial stunning is actually a form of TS and was the starting point
Post-ischemic myocardial stunning was the starting point of takotsubo syndrome: restitution
is justified after falling down on.
Madias hypothesis could be interesting in the discussion of the causal link between
SCAD and TS. Noteworthy, SCAD and TS afflict predominantly women and both conditions
can be induced by an emotional or extreme physical stress factors; thus, for us, an
unknown common pathogenesis for both disease entities could be a possibility.