A case of takotsubo cardiomyopathy caused by severe hyponatremia with underlying coronary artery-left ventricular fistulae = A case of takotsubo cardiomyopathy caused by severe hyponatremia with underlying coronary artery-left ventricular fistulae

다국어 초록 (Multilingual Abstract)

Background: Takotsubo cardiomyopathy is characterized by transient LV wall motion abnormality without coronary artery disease. It can be triggered by medical illness. Meanwhile, coronary fistulae are anomalous connection between coronary arteries and cardiac chambers or other vessels and are known to be generally asymptomatic, but rarely manifested by myocardial ischemia due to coronary steal syndrome. We report a unique case of takotsubo cardiomyopathy due to severe hyponatremia with coronary-LV fistulae. Case report: A 65-year-old female was referred to our hospital with the impression of AMI. Severe hyponatremia and elevated troponin-I with ST elevation on ECG was noted. Coronary angiography revealed multiple coronary fistulae originating from the diagonal branch of LAD and draining into LV cavity without any other coronary lesion. Echocardiography showed multiple linear flow signals from epicardium to endocardium at apical lateral wall, suggesting multiple coronary-LV fistulae. Her condition was recovered after conservative management. The follow-up echocardiography showed normal LV wall motion and systolic function. Doppler echocardiography revealed the decreased CFR in both coronary artery and fistula. Those suggest that the myocardium is susceptible to ischemia due to decrease in CFR, which may be associated with coronary fistula. Though we cannot conclude that coronary fistula contribute to the development of takotsubo cardiomyopathy, to the best of our knowledge, this is the first case of takotsubo cardiomyopathy with coronary-LV fistula.