Combinations of acute coronary syndromes and Takotsubo syndrome

摘要: The timely and refreshing case report by Tota et al, published in the August 16 issue of Journal [1], brings forth a matter that has occupied this author for some time, namely there must exist combinations acute coronary syndromes (ACS) Takotsubo syndrome (TTS) (as “forme fruste” cases TTS) [2-4]. authors present 70 year old woman with subacute stent thrombosis (SST) right artery transient left ventricular apical ballooning documentation normal flow circumflex arteries: thus here we have patient an ACS TS affecting different territories! are careful not to clearly state SST was cause or consequence TTS; however they provide evidence from literature other cardiac noncardiac pathologies patients admitted intensive care units been associated TTS, suggesting such illnesses acted as “triggers” (emotional physical stresses) emergence TTS. This does much doubt caused intuitively it is unlikely TTS mediated another vascular territory, although at stage thought evolution on pathogenesis should maintain open mind. A closely linked whether milder (i.e., formes frustes) significant proportion ACS. Indeed puzzling why regional wall motion abnormalities (RWMAs) also reveal RWMAs (hypokinesis akinesis) contralateral myocardial plane territory affected ACS, instead showing expected compensatory hyperkinetic behavior. Are these mild forms presenting combination traditional ACS? Finally note presented revealed attenuation QRS complexes her precordial electrocardiogram (ECG) leads between admission subsequent follow-up (compare V3-V6 ECGs, recorded 8 days apart Figure 3A 3B) possibly specific diagnostic, ECG sign which just reported [5].