title: Myocardial edema in Takotsubo syndrome mimicking apical hypertrophic cardiomyopathy: An insight into diagnosis by cardiovascular magnetic resonance.
abstract: Myocardial edema is one of the characteristic features in the pathogenesis of Takotsubo syndrome. We report a middle aged man who presented with typical clinical and echocardiographic features of apical variant of Takotsubo syndrome. However, a cardiovascular magnetic resonance study performed 10 days after presentation did not show any apical 'ballooning' but revealed features of an apical hypertrophic cardiomyopathy on cine images. Tissue characterization with T2 weighted images proved severe edema as the cause of significantly increased apical wall thickness. A follow-up cardiovascular magnetic resonance study was performed 5 months later which showed that edema, wall thickening and the appearance of apical hypertrophic cardiomyopathy all resolved, confirming Takotsubo syndrome as the cause of the initial appearance. As the affected myocardium most commonly involves the apical segments, an edema induced increase in apical wall thickness may lead to appearances of an apical hypertrophic cardiomyopathy rather than apical ballooning in the acute to subacute phase of Takotsubo syndrome.
authors: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK.
authors: Cemil
authors: C
authors: Izgi
authors: Department of Cardiology, Frimley Park Hospital NHS Foundation Trust, Frimley GU16 7UJ, Surrey, UK.
authors: Sanjoy
authors: S
authors: Ray
authors: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK.
authors: Evangelia
authors: E
authors: Nyktari
authors: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, Imperial College London, London, UK.
authors: Francisco
authors: F
authors: Alpendurada
authors: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, Imperial College London, London, UK.
authors: Alexander R
authors: AR
authors: Lyon
authors: Department of Cardiology, Frimley Park Hospital NHS Foundation Trust, Frimley GU16 7UJ, Surrey, UK.
authors: Sudhir
authors: S
authors: Rathore
authors: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, Imperial College London, London, UK. Electronic address: J.Baksi@rbht.nhs.uk.
authors: Arun John
authors: AJ
authors: Baksi
mesh_terms: D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004487:Edema / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009206:Myocardium / Q000473:pathology*; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis
keywords: Cardiovascular magnetic resonance; Edema; Hypertrophic cardiomyopathy; Myocardial hypertrophy; Takotsubo syndrome