PMC5376424_01
Coronary angiography, right anterior oblique view. (a) Note the presence of a relevant stenosis of the proximal segment of the left anterior descending artery (continuous arrow) and a moderate stenosis of the circumflex artery. (b) After the intracoronary injection of nitroglycerin not the reversibility of the left anterior descending stenosis.
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fig1
A coronary angiography was performed within the same day that revealed a moderate stenosis of the left circumflex coronary artery (dashed arrow in Figure 1(a)) as well as a localized spasm of the proximal LAD (white arrow in Figure 1(a)), which was reversible after intracoronary injection of 0.2 mg nitroglycerin (white arrow in Figure 1(b)).
Cardiac MR performed two weeks after the coronary angiography showing (a) apical edema in a T2 weighted TIRM black blood acquisition and (b) subendocardial late gadolinium enhancement in the apical region.
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fig2
The result of the examination was suggestive of the diagnosis of takotsubo cardiomyopathy with moderately reduced LV ejection fraction (Ejection fraction 44%), presence of myocardial edema in the apical region, and the presence of subendocardial late gadolinium enhancement in the apical region (Figures 2(a) and 2(b)).