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Patient
65-year-old woman hospitalized in the emergency ward for constrictive chest pain following the notification of the sudden death of her son; slight increase in troponin; ultrasound with pattern of major kinetic disorders of the apex and medial segments;
Trace
Entry ECG shows the presence of atrial fibrillation; moderate ST-segment elevation in V3; minimal Q-waves from V3 to V6 and in leads I, aVL; negative shallow T-waves from V1 to V5;
Trace
Coronary angiography revealed healthy coronary arteries, the angiography pattern in highly suggestive of Takotsubo's syndrome; ECG performed on D2; persistence of AF; disappearance of Q-waves from V3 to V6; negative, wide and deep T-waves in leads I, II, aVL, aVF and from V2 to V6;
Exergue
The electrocardiographic pattern of Takotsubo's syndrome evolves in 4 phases in conjunction with the onset of the symptoms; phase 1: in the first 6 hours, there is appearance of a diffuse elevation although not usually affecting the V1 lead; phase 2: from D1 to D3, a reversal of the T-waves may occur concomitantly with the elevation or its disappearance; phase 3: between D2-3 and D6, the T-waves may normalize; phase 4: a new wave inversion can be highlighted and persist for 2 to 12 weeks.
The complete normalization of the tracing in several days to a few weeks is observed in a vast majority of patients.
This observation highlights the different clinical, biological, electrocardiographic and angiographic characteristics of a Takotsubo's syndrome. A Takotsubo's syndrome is accompanied by dynamic electrocardiographic changes modifying the morphology of QRS-complexes, the ST-segment and the T-wave.