Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 47

may mimic an acute myocardial infarction. The typical presentation is acute substernal chest pain accompanied by dyspnea,
syncope, or shock (1, 4). Electrocardiographic changes may
include initial ST segment elevation followed by T wave inversion with QT prolongation throughout the anterior leads
(5, 6). Patients also typically have cardiac enzyme elevation
and an absence of significant coronary artery disease on angiogram (1).
Unlike an acute myocardial infarction, TC appears most
commonly in postmenopausal women. It is theorized that decreased sex hormones (specifically estrogen) in such women
predispose them to the condition, although there is currently no
clear explanation (4). The prevalence of TC ranges from 0.7%
to 2.2% of patients (from Japan and the Western hemisphere)
who present with acute coronary syndrome. The prognosis is
excellent. In a review by Gianni et al, the condition was noted to
have a mortality of only 1.1%, and almost all surviving patients
fully recover, with a recurrence rate <3% (4, 5).
There is a strong correlation between emotional stress and
TC. Our patient’s recent family stressors and chronic PHN
pain likely predisposed her to TC, with the thoracic epidural

April 2014

injection likely acting as the final trigger for her ensuing cardiac
event.
1.

2.
3.

4.

5.
6.

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Japan. Transient left ventricular apical ballooning without coronary artery
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Stress-induced (takotsubo) cardiomyopathy following thoracic epidural steroid injection for postherpetic neuralgia

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