Takotsubo cardiomyopathy: a case of persistent apical ballooning complicated by an apical mural thrombus.
Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Pil Hyung
PH
Lee
Jae-Kwan
JK
Song
In Keun
IK
Park
Byung Joo
BJ
Sun
Seung Geun
SG
Lee
Ji Hye
JH
Yim
Hyung Oh
HO
Choi
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002395:Catecholamines / Q000097:blood; D002637:Chest Pain; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013927:Thrombosis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002395:Catecholamines; D004232:Diuretics