Takotsubo cardiomyopathy, also known as Gebrochenes-Herz syndrome, transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, or broken heart syndrome, is a rare disease triggered by stressful events, such as a high plasma concentration of catecholamines and their metabolites, which resembles acute coronary syndrome. It is characterized by transient regional systolic dysfunction of the left ventricle mimicking acute myocardial infarction. The term Takotsubo originates from the Japanese word for an "octopus trap," which resembles the shape of the ventricle during systole. A 28-year-old woman in the early postpartum period presented to the emergency department with a sudden onset retrosternal chest pain and shortness of breath. At first, electrocardiography and laboratory evaluation workups suggested acute coronary syndrome. Transthoracic echocardiography revealed hypokinesia of the basal and mid left ventricular segments with preserved apical contractility, resulting in a left ventricular ejection fraction of 35%. The patient underwent immediate coronary angiography, which showed normal coronary arteries as well as no obstructive disease. Follow-up echocardiography showed recovery of left ventricular function with an improvement of the left ventricular ejection fraction to 55%, consistent with a diagnosis of reverse Takotsubo cardiomyopathy, occurring in the postpartum period which is an important STEMI mimic. Takotsubo cardiomyopathy is an important differential diagnosis in postpartum women presenting with acute coronary syndrome-like symptoms and requires careful multimodal evaluation to distinguish it from peripartum cardiomyopathy and myocarditis. The patient stabilized following supportive management, with complete recovery of left ventricular function.

Following up on a previous article written by Lindow et al, this article aims to further discuss a switch from STEMI to Occlusion Myocardial Infarction (OMI). The article explains how OMI can be diagnosed both with or without the ECG, it criticises how the STEMI criteria were created and how they are often used as lone rule-in criteria for acute angiography. False positive STEMI lead to many unnecessary angiographies, while OMI shows better sensitivity, and multiple AI models based on OMI have retrospectively shown to be very promising in choosing which patients need immediate intervention. Using OMI is proposed to lead to less delayed interventions, but this subject needs further investigation; however, prospective studies of OMI as determinant of urgent intervention are ongoing. The authors therefore believe OMI could be implemented within the near future.

Cardiac myosin-binding protein C (cMyBP-C) is a cardiac-restricted sarcomeric protein; after cardiomyocyte injury, circulating intact cMyBP-C and/or cMyBP-C fragments, collectively referred to here as the cMyC biomarker signal, appear rapidly in blood. In suspected acute coronary syndrome (ACS), its most important potential role is not as another marker of injury but as a decision-enhancing biomarker beyond symptoms, electrocardiography, cardiac troponin T and I concentrations measured with high-sensitivity assays (hs-cTnT and hs-cTnI), time from pain onset, and pre-test probability. This narrative review separates three clinical tasks frequently conflated in the biomarker literature: diagnosis of acute myocardial infarction, emergency-department triage, and prediction of short-term or post-infarction risk. We integrate cMyBP-C sarcomeric architecture, N-terminal regulatory biology, phosphorylation, proteolysis, circulating fragments, assay epitopes, analytical stability, diagnostic algorithms, point-of-care testing, ST-segment elevation myocardial infarction reperfusion biology, and major confounders including renal dysfunction, heart failure, age, sex, and chronic ventricular remodeling. Current evidence supports further evaluation of cMyC as an adjunct in early presenters and accelerated diagnostic pathways. However, diagnostic safety and efficacy have not been consistently reproduced across platforms and populations, and external validation-particularly of rule-out performance-remains insufficient for routine clinical use. Recurrent injury assessment and post-infarction risk phenotyping remain promising but incompletely validated applications. Before guideline adoption, cMyC needs phenotype-specific, multicenter implementation trials demonstrating incremental net benefit, cost-effectiveness, and patient-level safety compared with contemporary hs-cTnT- and hs-cTnI-based clinical decision algorithms.

A healthy man in his 40s presented with acute anterolateral ST-segment elevation myocardial infarction after sudden-onset chest pain during a coughing episode. Coronary angiography and intravascular ultrasound revealed extensive spontaneous coronary artery dissection (SCAD) of the left anterior descending artery with Thrombolysis in Myocardial Infarction II distal flow. He was managed conservatively, but his course was complicated by severe left ventricular systolic dysfunction, apical thrombus and a ventricular tachycardia storm leading to cardiogenic shock. He required repeated emergency direct-current cardioversions, intravenous amiodarone, lidocaine and intra-aortic balloon pump support. Cardiac magnetic resonance imaging confirmed extensive myocardial infarction. Clinical recovery was achieved without revascularisation, and an implantable cardioverter-defibrillator was implanted for secondary prevention alongside guideline-directed heart failure therapy. At follow-up, he remained clinically stable. This case highlights that SCAD, although uncommon in men, can present with life-threatening complications and that carefully tailored conservative management with multidisciplinary input may achieve favourable outcomes.

Fluorouracil (5-FU) is frequently used in chemotherapy for several cancers, but adverse effects such as electrocardiography (ECG) ST-T changes and vascular spasms have been reported. Here, we present a case in which 5-FU triggered coronary vasospastic angina and takotsubo syndrome. A 65-year-old woman was admitted to our hospital for treatment of esophageal adenocarcinoma and initiated on 5-FU, leucovorin, and oxaliplatin. Three days after administration, she experienced chest pain that resolved spontaneously. On the fifth day, she was referred to our department. ECG showed ST-segment elevation in leads II, III, and aVF, with T-wave inversion in leads I, aVL, and V1-6. Echocardiography revealed wall motion abnormalities predominantly at the apex. Cardiac computed tomography showed no significant coronary artery stenosis. An acetylcholine provocation test was performed, revealing multi-vessel spasm, leading to a diagnosis of coronary vasospastic angina. Coronary vasodilators were initiated, and the chemotherapy regimen was changed to discontinue 5-FU. The patient experienced no recurrence of chest pain, and improvements were observed in both echocardiographic and ECG findings. Reports of takotsubo syndrome caused by 5-FU are rare, and its mechanism remains unclear. In this case, the presence of coronary vasospastic angina suggests that it may have contributed to the development of takotsubo syndrome.

Refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest is associated with high mortality, particularly when resuscitation is prolonged. Early cardiopulmonary resuscitation (CPR), rapid defibrillation, and comprehensive post-return of spontaneous circulation (ROSC) care are critical determinants of survival. A 46-year-old previously healthy man collapsed during exercise. Immediate bystander CPR was initiated. Emergency medical services identified VF as the initial rhythm and delivered multiple defibrillation shocks along with antiarrhythmic therapy. On hospital arrival, the patient remained in persistent VF, and advanced cardiac life support was continued. ROSC was achieved after prolonged resuscitation but was followed by a brief re-arrest. Sustained ROSC occurred after a total CPR duration of approximately 85 minutes, during which 20 defibrillation shocks were administered. Advanced airway management and pharmacologic therapy, including epinephrine, amiodarone, lidocaine, and magnesium, were provided. Following ROSC, the patient developed severe hemodynamic instability requiring mechanical ventilation, intravenous fluids, and high-dose vasopressors. Electrocardiography demonstrated diffuse ST-segment depression with subtle ST-segment elevation in leads aVR, aVL, and V1, suggestive of an acute ischemic etiology. Neurological examination revealed preserved brainstem reflexes. Active temperature control was initiated, and the patient was transferred for urgent coronary angiography and management in the coronary care unit. Coronary angiography confirmed complete proximal left anterior descending artery occlusion, and primary percutaneous coronary intervention with drug-eluting stent implantation was performed. The subsequent hospital course was complicated by cardiogenic shock, complete atrioventricular block requiring temporary transvenous pacing, and recurrent ventricular tachycardia/ventricular fibrillation triggered by frequent premature ventricular complexes with an R-on-T pattern. Repeat coronary angiography confirmed a patent left anterior descending artery (LAD) stent with TIMI (Thrombolysis in Myocardial Infarction) III flow. The patient survived and achieved good neurological recovery, with a Glasgow Coma Scale score of 15/15 after extubation. This case illustrates survival after prolonged resuscitation for refractory VF, emphasizing the importance of early bystander CPR, persistent advanced life support, urgent coronary revascularization, careful rhythm management, and comprehensive post-cardiac arrest care. In selected patients, extended resuscitative efforts may result in meaningful survival despite prolonged cardiac arrest.

Acute coronary syndrome (ACS) is a life-threatening condition that typically presents with chest pain, dyspnea, or chest discomfort. However, atypical manifestations occur in a considerable proportion of patients and may lead to delayed diagnosis and treatment. Gastrointestinal symptoms such as nausea and vomiting are relatively common in inferior wall myocardial infarction, whereas diarrhea is an extremely rare presenting symptom. We report the case of a 38-year-old man with no known past medical history who presented to the emergency department with multiple episodes of acute diarrhea without abdominal pain or chest discomfort. Initial clinical evaluation suggested acute gastroenteritis; however, electrocardiography revealed ST-segment elevation in the inferior leads. The patient was diagnosed with ST-elevation myocardial infarction (STEMI) and received immediate treatment including dual antiplatelet therapy and thrombolysis, followed by coronary angiography and stent placement in the right coronary artery. This case highlights the importance of considering atypical presentations of ACS in emergency settings and emphasizes the role of early electrocardiographic evaluation even in patients presenting with non-cardiac symptoms.

Pheochromocytoma is a rare catecholamine-secreting tumour with diverse cardiovascular manifestations. Presentation with chest pain and troponin elevation may closely mimic acute coronary syndrome (ACS), potentially leading to diagnostic delay.