DOI: 10.36347/sjmcr.2022.v10i04.029

Pages: 387-389

Background: Tako-tsubo syndrome (TTS) refers to the apical ballooning of the left ventricle observed when angiographic ventriculography is performed in patients presenting with electrocardiographic changes suggestive of acute coronary syndrome (new transient ST-segment deviation (>0.05 mV) or T-wave inversion (>0.2 mV)), mild elevation of cardiac markers, but normal coronary arteries at the angiogram. Case report: A 49-year-old woman developed the characteristic features of TTS 24 hours following tricyclics (amitriptyline hydrochloride) overdose. The admission ECG showed inverted deep T waves in lateral leads (I, AVL). There was an increase in us- troponin level. Transthoracic echocardiography showed hypokinetic anterior and anterolateral segments in the median slice with apical akinesia. Her angiogram was normal. The ventriculography showed an apical ballooning of left ventricle. In contrast, a complete recovery of left ventricular function was observed within one week. Discussion: The pathophysiology of TTS, a variant of myocardial stunning, is still incompletely understood but could be related to sympathetic overstimulation. The possibility of TTS following toxic tricyclics exposure is discussed.