A Diagnostic Challenge: Takotsubo Cardiomyopathy with Concomitant Coronary Artery Disease

Background : Takotsubo cardiomyopathy (TCM), often referred to as stress-induced cardiomyopathy, typically mimics acute coronary syndromes but without significant obstructive coronary artery disease. However, recent studies have reported the coexistence of TCM with coronary artery lesions, posing diagnostic and therapeutic challenges. Case Summary : We report the case of a 72-year-old woman presenting with acute chest pain and ST-segment elevation. Coronary angiography revealed mid-LAD stenosis, while echocardiography showed apical ballooning. Left ventriculography and subsequent cardiac MRI confirmed Takotsubo cardiomyopathy. A conservative medical strategy was adopted due to the discordance between the wall motion abnormalities and the coronary lesion territory. The patient had a favorable clinical evolution with full recovery of systolic function at 6 weeks. Conclusion : This case underlines the importance of multimodal imaging and clinical context in differentiating TCM from true myocardial infarction, particularly in patients with coexisting coronary artery disease.