Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?

Takotsubo cardiomyopathy and acute coronary syndromes: Are they always mutually exclusive?

“…In clinical practice, takotsubo cardiomyopathy (TTC) and acute coronary syndromes (ACS) may not always appear to be mutually exclusive potentially denoting a co-existence of these two conditions in a portion of suspected ACS admissions 1, 2. Within this context, absence of critical coronary lesions through coronary imaging might, to a large extent, be suggestive of TTC in isolation in patients with suspected ACS.…”

“…Firstly, spontaneous coronary artery dissection (SCAD) has emerged as a distinct phenomenon mostly presenting with an ACS in clinical practice 1 . More importantly, there may exist a subtle relation between SCAD and TTC largely owing to the common origin of these conditions (excessive endogenous stress with adrenergic hyperactivation) 1 . Furthermore, an ACS associated with SCAD may serve as a substantial trigger of TTC during its course 1 .…”

“…More importantly, there may exist a subtle relation between SCAD and TTC largely owing to the common origin of these conditions (excessive endogenous stress with adrenergic hyperactivation) 1 . Furthermore, an ACS associated with SCAD may serve as a substantial trigger of TTC during its course 1 . Therefore, it should be borne in mind that an ACS presentation with an existing SCAD appearance on CAG might be suggestive of an accompanying TTC necessitating further investigation of the patient.…”

“…Lastly; co-existence of ACS and TTC might be associated with a variety of adverse outcomes including acute heart failure, mechanical complications as well as arrhythmogenesis and sudden cardiac death (SCD) (as compared with ACS in isolation) 1 . However, the evolution and magnitude of these complications largely depend on the intensity of the common trigger (inflammation, etc.)…”

“…However, an existing severe CAD might not always signify an accompanying ACS, and might also appear only as a silent bystander in the setting of TTC. Accordingly, a variety of risk factors1, 2, 3, 4, 5, 6 may potentially aid in the identification of patients with a potential ACS-TTC co-existence in clinical practice. However, despite the guidance of these risk factors, definitive diagnosis of such a co-existence may be quite challenging through basic modalities particularly when these two conditions involve the same or largely intersecting myocardial territories.…”