Classical apical ballooning with significant stenosis of the left anterior descending coronary artery: is cardiac magnetic resonance imaging the solution for this diagnostic dilemma?

Takotsubo cardiomyopathy (TTC) is characterized by an acute, but transient myocardial dysfunction with distinct left ventricular wall motion abnormalities (WMAs), mimicking an acute coronary syndrome (ACS). The current pathophysiologic hypothesis postulates a major role of catecholamine excess and enhanced sympathetic activity [1]. About 1–2 % of patients with ACS turn out to be affected by TTC [2]. Initially, the absence of significant coronary artery disease (CAD) was a prerequisite for the diagnosis of TTC. However, in the revised Mayo Clinic diagnostic criteria for TTC, the presence of CAD in vessels not supplying dysfunctional myocardium is no longer an exclusion criterion to establish the diagnosis [3]. According to recent reports, the prevalence of various degrees of CAD in patients with TTC ranged from 10 to 60 % [1, 4, 5]. This increased recognition of the coexistence of CAD and TTC, however, comprises diagnostic and therapeutic challenges. Herein, we present two cases...