PMC9242792_01
Electrocardiogram at presentation.
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Initial troponin was normal 0.002 ng/mL (<0.045), and electrocardiogram revealed sinus tachycardia and ventricular rate of 121 with no repolarization abnormalities (Figure 1).
Electrocardiogram on admission day 3.
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However, on admission day three, he developed new onset atrial fibrillation with rapid ventricular response, chest pain, refractory hypotension, and EKG indicating anterior ST-elevation myocardial infarction (Figure 2).
(a) Ventriculography of the left ventricle in systole showing basal and midventricular hypokinesis. (b) Ventriculography of the left ventricle in diastole. (c) Coronary angiography showing normal coronaries.
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Coronary angiography with ventriculography revealed normal coronaries, basal and midventricular hypokinesis with hyperdynamic left ventricular apex, and ejection fraction of 35%, indicating reverse and midventricular takotsubo cardiomyopathy (Figures 3(a)-3(c)).