TAKOTSUBO SYNDROME IN A PATIENT TRANSPLANTED WITH SCA: A CASE REPORT

Introduction: In patients undergoing orthotopic cardiac transplantation (OHT), the outcome following acute coronary syndrome (ACS) is significantly worse than in patients with native heart. However, there is a lack of data in the literature on the incidence and outcome of SCA in the absence of angiographically significant coronary disease (MINOCA). Method: A 75-year- old woman, who underwent OHT in 2010, entered the PS for oppressive chest pain associated with dyspnea and paresthesia in the upper left limb. The ECG of entry showed widespread abnormalities of ventricular recovery, with negative T waves in D1, aVL, V4-V6. The echocardiographic observation performed in PS showed a severe reduction of EF (38%) with acinesia of the toto apex and middle segments of the interventricular septum and posterior wall. In laboratory tests, increased levels of myocardionecrosis enzymes were observed. Results: The patient underwent coronary angiography, which concluded for “atheromasic epicardial coronaries, in the absence of angiographically significant lesions”. He performed cardiac NMR in the following days, which showed tissue characterization images compatible with the presence of diffuse phlogy involvement of the middle-ventricular segments of the left ventricle in the absence of necrosis areas. These morpho-functional and tissue elements were consistent with the clinical suspicion of stress-syndrome cardiomyopathy of Takotsubo. Conclusions: Takotsubo syndrome is a rare but possible cause of SCA in patients undergoing OHT. A possible cause has been identified in an altered reinnervation of the transplanted heart, with imbalance between sympathetic and parasympathetic nervous system and consequent excessive release of catecholamines.