Takotsubo cardiomyopathy and spontaneous coronary artery dissection association mimicking peri-partum cardiomyopathy

Abstract

A 34-year-old woman presented with oppressive chest pain and dyspnea, later progressing to acute pulmonary edema four days after her fourth delivery. Echocardiography revealed severe left ventricular systolic dysfunction. Coronary angiography demonstrated a multivessel spontaneous coronary artery dissection (SCAD) of very small < 1 mm branches of RCA and diagonal arteries that did not explain the reduction in LVEF to 35 %. Ventriculography confirmed a reversed Tako-Tsubo pattern. Cardiac MRI helped distinguish between Tako-Tsubo syndrome (TTS) and peripartum cardiomyopathy (PPCM), as both can share a similar pattern. The patient received heart failure guideline-directed medical therapy, resulting in rapid clinical improvement. This case highlights the diagnostic challenge not only in identifying SCAD, TTS, and PPCM in the peripartum period, but also in recognizing the potential overlap between them. Multimodal imaging in guiding effective management of peripartum cardiovascular complications was therefore crucial.