Takotsubo cardiomyopathy: important differential diagnosis of chest pain in the emergency room/Miocardiopatia de Takotsubo: importante diagnostico diferencial de dor toracica na emergencia

Takotsubo cardiomyopathy is a form of acute, usually reversible, heart failure triggered by physical or emotional stress. The clinical presentation is very similar to that of acute coronary syndromes, but without the characteristic vascular obstruction of coronary disease. Here we report a case of a 53-year-old woman who presented at the cardiac emergency room with typical coronary chest pain, dynamic electrocardiogram changes, and increased markers of myocardial necrosis. Cardiac catheterization showed coronary arteries without significant atheromatosis, despite a slight degree of atherosclerosis, and findings suggestive of Takotsubo cardiomyopathy of the apical type. Supportive treatment with antihypertensive drugs was performed, aiming to reduce cardiac workload and remodeling. Markers of myocardial necrosis monitored during hospitalization showed a downward curve. The patient had clinical improvement, being discharged on the 7th day after hospitalization, using angiotensin-converting enzyme inhibitor, third-generation beta-blocker, statin and platelet antiaggregants. Keywords: Takotsubo cardiomyopathy; Cardiomyopathies; Spasm. A miocardiopatia de Takotsubo e uma forma de insuficiencia cardiaca aguda, geralmente reversivel e desencadeada por um estresse fisico ou gatilho emocional, cuja apresentacao clinica e bastante similar as sindromes coronarianas agudas, porem sem a obstrucao vascular caracteristica da doenca coronariana. Relatamos o caso de uma mulher de 53 anos que chegou a emergencia cardiologica com dor retroesternal tipicamente coronariana, alteracoes dinamicas no eletrocardiograma e aumento dos marcadores de necrose miocardica. Cateterismo cardiaco mostrou coronarias isentas de ateromatose significativa, embora houvesse pequeno grau de aterosclerose, e achados sugestivos de miocardiopatia de Takotsubo do tipo apical. Foi realizado tratamento de suporte com drogas anti-hipertensivas, visando diminuir trabalho e remodelamento cardiacos. Os marcadores de necrose miocardica acompanhados durante o internamento mostraram curva descendente. Paciente evoluiu com melhora clinica, recebendo alta hospitalar no 7[degrees] dia apos internamento, em uso de inibidor da enzima conversora de angiotensina, beta bloqueador de 3a geracao, estatina e antiagregante plaquetario. Descritores: Cardiomiopatia de Takotsubo; Cardiopatias; Espasmo.