Takotsubo Syndrome and Spontaneous Coronary Artery Dissection

Myocardial infarction (MI) and Takotsubo syndrome (TTS) are rare causes of chest pain in young female patients. A 36-year-old woman presented with acute chest pain that started after an extreme cough. The electrocardiogram revealed inferior ST-segment elevations, but bedside echocardiography showed apical ballooning indicative of TTS. Invasive angiography appeared normal. However, cardiac magnetic resonance imaging confirmed the coexistence of an inferolateral transmural MI and TTS. Re-analysis of the angiogram raised suspicion for spontaneous coronary artery dissection of the second obtuse marginal branch. This challenging case demonstrates a peculiar combination of events with spontaneous coronary artery dissection causing an ST-segment elevation MI and consecutive TTS and the diagnosis of bystander patent foramen ovale.