Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block Requiring Cardiac Resynchronisation Therapy Pacemaker.

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or apical ballooning syndrome, is increasingly recognised as an acute myocardial ischemic syndrome primarily involving transient microvascular dysfunction rather than epicardial coronary occlusion and characterised by transient left ventricular dysfunction. Patients are predominantly postmenopausal women and may clinically mimic acute coronary syndrome, including ST-elevation myocardial infarction (STEMI) as well as non-ST-elevation myocardial infarction (NSTEMI). While TTS may coexist with obstructive coronary artery disease (CAD), the hallmark feature is a mismatch between the severity of wall motion abnormalities and the distribution of any coronary lesions. We present a postmenopausal lady who presented as a presumed STEMI but was eventually diagnosed to have takotsubo cardiomyopathy. She developed a persistent high-grade AV block with poor ejection fraction and was subsequently implanted with a cardiac resynchronisation therapy pacemaker (CRT-P).