Coronary embolisation of a left ventricular fibroelastoma mimicking a thrombus and triggering Takotsubo cardiomyopathy

We describe a case of a woman in her 70s who presented with acute chest pain and ST-segment elevation on ECG. Multimodality cardiac imaging confirmed Takotsubo cardiomyopathy alongside a pedunculated left ventricular mass, presumed to be a thrombus, with suspected embolisation to the left anterior descending artery, triggering an acute myocardial infarction. She received guideline-directed medical therapy for heart failure and anticoagulation for the thrombus. Her ejection fraction subsequently recovered. However, after 7 months of anticoagulation, serial imaging showed persistent ventricular mass, raising concern for an alternative diagnosis. Surgical resection of the mass revealed fibroelastoma, an unexpected finding given its atypical location. The initial hypothesis was revised to tumour emboli triggering the Takotsubo cardiomyopathy. This case underscores the importance of considering atypically located cardiac tumours in coronary embolisation with myocardial ischaemia, particularly in patients without traditional cardiovascular risk factors.