A Case Report of Takotsubo Cardiomyopathy Masquerading as Acute Coronary Syndrome: A Diagnostic Challenge

Presentations of Takotsubo cardiomyopathy (TTC) may resemble those of acute coronary syndrome (ACS), including symptoms such as severe chest pain, elevated troponins, and dynamic ECG changes. Early recognition is crucial to avoid unnecessary interventions. We report the case of a 70-year-old female who presented with sudden-onset severe left-sided chest pain, markedly elevated but down-trending troponins, and an ECG showing dynamic, diffuse T-wave inversions. Echocardiography revealed preserved basal contraction with apical akinesia and an ejection fraction (EF) of 25%. Coronary angiography demonstrated unobstructed coronaries. She was initially managed medically under the ACS protocol with careful risk stratification until the diagnosis was confirmed on coronary angiography, after which she was managed conservatively. Follow-up echocardiography at 4 weeks showed recovery of EF to 55% without intervention, confirming TTC. ACS-like presentations with down-trending troponins, basal contraction with apical akinesia on echocardiography, diffuse ECG changes, and resolving chest pain may represent TTC. Careful risk stratification can guide the safe timing of angiography, avoid unnecessary urgent transfer to the nearest percutaneous coronary intervention (PCI) centre, and ensure continued medical ACS management until the diagnosis is confirmed on coronary angiography combined with left ventriculography.