2024, Volume 31 (online first)

A 59-year-old woman presented to the emergency room with sudden onset of retrosternal thoracic pain following emotional stress. The electrocardiogram (ECG) revealed T-wave inversions on precordial leads. Her blood analyses demonstrated elevation of myocardial necrosis markers (peak of troponin I of 3.4 ng/ml). Transthoracic echocardiogram (TTE) findings were consistent with Takotsubo syndrome, accompanied by mild left ventricular dysfunction. The patient underwent invasive coronary angiography revealing a spontaneous coronary artery dissection in the left anterior descending artery and left main artery. A repeat TTE one week later showed complete resolution of the segmental contractility with a full recovery of left ventricular function. Cardiac magnetic resonance imaging revealed no abnormalities. The patient was discharged on dual-antiplatelet therapy. A follow-up coronary angiography performed one month later confirmed complete resolution of the dissection. Takotsubo syndrome and spontaneous coronary artery dissection predominantly affect women and share common triggers. This case highlights the often misdiagnosed association and emphasises the specific diagnosis and treatment nuances associated with it.

Cardiac metastases normally reflect diffuse metastatic spread of the primary tumour and are rarely found in isolation. We present a case of a 71-year-old man with a history of completely resected high-grade spindle cell sarcoma of the left thigh, who presented with shortness of breath, and was found to have a large right ventricular mass, subsequently diagnosed as a metastasis of the prior sarcoma. It was deemed inoperable and incurable, and the patient was offered palliative chemotherapy. Unfortunately, the patient died within four months of his original presentation.