A rare combination: tako-tsubo cardiomyopathy, a left ventricular thrombus and acute pancreatitis secondary to drug overdose Case report

Abstract

A female patient aged 47 was admitted to hospital due to suspected acute coronary syndrome, experiencing chest pain prior to presentation. The ECG showed non-specific changes in the ST–T wave, with negative T waves in leads I, II and V2–V6 and elevated cardiac necrosis markers were revealed in serum. Prior to presentation of the symptoms, the patient was under pressure and attempted a suicide by ingesting metoprolol and simvastatin, a strip of each according to the patient’s account. The clinical symptoms suggested acute coronary syndrome and an urgent coronary angiogram was performed. The result did not show abnormalities in the coronary vessels. Echocardiography showed the following: normal ventricular sizes, akinesis in the apical region of the anterior and lateral walls and the interventricular septum as well as hypokinesis in the medial segments of the lateral wall and the interventricular septum. Psychiatrist who diagnosed an acute response to stress and established that drug overdose was situation-related. On the initial days of her hospital stay, the patient reported abdominal pain accompanied by an elevated levels of C-reactive protein (CRP) and pancreatic enzymes. Abdominal ultrasound and CT scans were ordered which revealed acute pancreatitis. The course of events which initiated the symptoms, specifically the emotional stress, is highly typical for the tako-tsubo syndrome. Nevertheless, the pain which was the direct reason for hospital admission could have been a symptom of both the tako-tsubo syndrome and pancreatitis.