When not dying breaks the heart!

Abstract

Introduction: Takotsubo cardiomyopathy (TC) is a reversible cardiac pathology that develops contractility changes in the middle segments of the left ventricle, often precipitated by a stressor event, and which clinically mimics an acute coronary event. It mainly affects postmenopausal women and presents with clinical, electrocardiographic and laboratory characteristics similar to acute coronary syndrome, always constituting a differential diagnosis of this entity. It can be triggered by a physical or emotional stressor. The pathophysiology of TC remains unknown.Case report: We present a clinical case that poses a diagnostic challenge as the clinical presentation did not indicate cardiac comorbidity. 78-year-old woman was referred to the Emergency Department for attempted suicide by drowning in a river. She presented with a depressive mood reactive to recent experiences, social isolation, overvalued thoughts of worthlessness and guilt. She denied complaints of chest pain or dyspnea. Of the complementary diagnostic tests performed on admission, ECG shows sinus rhythm with ST elevation in V2 stand out. Collaboration from the cardiology was requested and it was assumed Takotsubo syndrome as a probable diagnosis. During hospitalization, there was a good clinical evolution, presenting good clinical response and remission of depressive symptoms.Conclusion: TC is a psychosomatic condition that requires a multidisciplinary approach in the treatment of heart and psychiatric disease. Clinicians should suspect TC in patients who report a recent stressful event accompanied by cardiothoracic symptoms. Since many cases are seen primarily by psychiatry, psychiatrists must be familiar with the syndrome, under penalty of delay in diagnosis and treatment.