JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Figure 1. 12 lead ECG showing normal sinus rhythm at a rate of 59 beats per minute, a normal axis and no acute ischemic changes.
Figure 2. 12-lead ECG showing normal sinus rhythm at a rate of 68 beats per minute and inferior ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in V3, V4, and aVL.
Figure 3. Selective left coronary arteriogram, LAO caudal view, showing diffuse spasm, including spasm of the distal left main.
Figure 4. Selective left coronary arteriogram, LAO caudal view after injection of intracoronary nitroglycerin and verapamil, showing near resolution of severe diffuse spasm of left coronary system.
in 21%. Coronary arterial spasm contributes less than 1% of postpartum complications noted on cardiac catheterization. 1 Vasocontrictive agents such as ergonovine, bromocriptine, and prostaglandin E2, which are frequently used during pregnancies, have been shown to increase the incidence of peripartum vasospasm. Takotsubo cardiomyopathy should also be included in the differential diagnosis of peripartum chest pain. This is a transient systolic dysfunction that can be precipitated by emotional or physical stress. Classically, it involves the left ventricular apical
segment but it can sometimes involve the mid-segments or even the base of the heart, giving symptoms that mimic a myocardial infarction (MI). 2 The most widely accepted theory is catecholamine-mediated vascular dysfunction causing coronary artery vasospasm and leading to ST elevation in the anterolateral leads. 3 Differentiating features between Takotsubo cardiomyopathy and acute coronary vasospasm include the presence of global wall motion hypokinesis or apical ballooning in Takotsubo cardiomyopathy, asopposedtoregionalwallmotionabnormality
102 J La State Med Soc VOL 169 JULY/AUGUST 2017
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