Coronary artery systolic “milking” and “bridging” in Takotsubo syndrome: substrate or an epiphenomenon?


  • John E Madias 1, Icahn School of Medicine at Mount Sinai, New York, NY 2. Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY


[first paragraph of article]

To The Editor:

I enjoyed reading the case report by Spadotto et al. published in issue 2 (2013) of the Journal about a 66-year-old woman with Takotsubo syndrome (TTS), involving the mid-apical segment of the left ventricle (LV), severe dynamic mid-ventricular gradient and mitral regurgitation, with systolic anterior motion of the anterior mitral leaflet caused by the hyperkinetic basal segments, with generation of a peak intra-ventricular gradient of 48 mmHg, and mild systolic “milking” of the mid to distal segment of the left anterior descending coronary artery (LAD). Cardiac magnetic resonance imaging (cMRI) showed intense myocardial edema of the mid-apical LV segments. 






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