A case of Takotsubo syndrome with polymorphic ventricular tachycardia and shark fin electrocardiogram developed during hospitalization for occlusive arterial disease of the lower extremities.

A 93-year-old man was admitted to our hospital with complaints of pain and coldness in both lower legs. He was diagnosed with arterial occlusive disease of the lower extremities. There were no obvious stenosis or occlusion of lower extremity arteries, which would be indications for surgery, and drug therapy was started. On the 8th day of hospitalization, after complaining of feeling unwell, polymorphic ventricular tachycardia appeared in a few seconds and the electrocardiogram (ECG) showed shark fin like ST-segment elevation in the leads V1-6. Echocardiography demonstrated akinesis in the anterior septum and akinesis from middle to apical anterior left ventricular wall, which suggested acute coronary syndrome. Emergency coronary angiography was performed and no obvious severe stenosis, thrombus, or dissection was observed on intravascular ultrasonography and changes due to ischemic heart disease were judged to be negative. Left ventricular angiography confirmed decreased wall motion throughout the apex, and the patient was considered to have takotsubo syndrome. Echocardiography on the 20th day of hospitalization showed that the wall motion abnormality had improved except the apex, and the ECG showed negative T wave conversion. The patient was discharged on the 33rd day of hospitalization. Learning objectives: This case highlights the diverse electrocardiographic manifestations of takotsubo syndrome (TTS). In particular, rare electrocardiographic changes were observed in an elderly male patient with TTS.