Tako-tsubo Cardiomyopathy Following Colonoscopy: Insights on Pathogenesis

We report a case of Tako-tsubo cardiomyopathy (TTC) occurring after colonoscopy. A 60-year-old post menopausal female with syncope following an acute abdominal syndrome underwent diagnostic colonoscopy. Anginal chest pain with marked ST segment elevation occurred the day following the procedure. Coronary angiogram was entirely normal, but left ventriculography showed marked reduction in systolic function along with mid ventricular and apical akinesis. The patient's symptoms completely improved with eventual normalization of ventricular function. The occurrence in this patient of initial vagal syndrome followed by sympathetic stimulation preceding TTC is compared to prior reports with similar provocateurs and implications for pathogenesis discussed.