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JAW CLAUDICATION AS AN ATYPICAL MANIFESTATION OF AORTIC THORACIC DISSECTION IN ELDERLY PEOPLE

ventricular function returned to normal 7 days later. This report demonstrates that T-wave inversion on telemetry monitoring might be useful for detecting the onset of tako-tsubo cardiomyopathy in patients in a coma. Since tako-tsubo cardiomyopathy was first reported in 1990, this disorder has been recognized worldwide. Most patients have been elderly women, symptoms are similar to those of acute myocardial infarction, and patients have often experienced emotional or physical stress before onset. Tako-tsubo cardiomyopathy should be considered in the differential diagnoses of acute myocardial infarction. In our case, acute stress due to brain infarction could have been a precipitating factor leading to tako-tsubo cardiomyopathy. Because apical ballooning of tako-tsubo cardiomyopathy is transient and resolves dramatically in a short time, its prognosis is generally favorable, although recent reports have demonstrated early life-threatening complications, including left ventricular rupture, arrhythmia, heart failure, cardiogenic shock, and apical thrombus formation. Early diagnosis and subsequent treatment are required to prevent these complications even in patients with tako-tsubo cardiomyopathy. Tako-tsubo cardiomyopathy often occurs as a complication of noncardiac disorders. The development of takotsubo cardiomyopathy may be diagnosed at a later stage or overlooked, especially in patients who are in a coma. Clinicians should recognize that there is a possibility of the development of tako-tsubo cardiomyopathy when T-wave inversion appears in patients with noncardiac disorders during hospitalization. Transthoracic echocardiography or repeated electrocardiogram should be performed routinely in these patients.