Tako-tsubo Syndrome after Acute Traumatic Subdural Hematoma Mimicking Acute ST Elevation Myocardial Infarction

ABSTRACT

Electrocardiographic changes frequently occur after severe physical or emotional stress. Such changes can mimic acute ST-segment elevation myocardial infarction with elevated serum cardiac-specific markers (CK-MB, Troponin I), segmental wall motion abnormalities, and myocardial dysfunction. Several reports, however, have found that coronary angiography revealed no significant stenosis. We present a 70-yearold female with a traumatic subdural hematoma testing positive for cardiac enzymes, and ECG changes suggestive of acute ST-segment elevation myocardial infarction. Such a case, however, fits the diagnostic parameters of Tako-tsubo cardiomyopathy, or Tako-tsubo syndrome; even though its etiology, pathophysiology, diagnosis, and treatment remain uncertain. Tako-tsubo syndrome is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber, but a favorable outcome with appropriate medical therapy is expected. Because of its unusual nature and favorable prognosis, it is clear that Tako-tsubo syndrome is an important affliction that should be recognized by any emergency department.