J Cardiovasc Ultrasound.  2013 Sep;21(3):137-139. 10.4250/jcu.2013.21.3.137.

A Case of Persistent Apical Ballooning Complicated by Apical Thrombus in Takotsubo Cardiomyopathy of Systemic Lupus Erythematosus Patient

• Shim IK
• Kim BJ
• Kim H
• Lee JW
• Cha TJ
• Heo JH

• KMID: 1500193
• DOI: http://doi.org/10.4250/jcu.2013.21.3.137

Abstract

Takotsubo cardiomyopathy, which is also known as "transient apical ballooning", is a cardiac syndrome associated with emotional and physical stress that occurs in postmenopausal women. It may mimic acute coronary syndrome but coronary angiography reveals normal epicardial coronary arteries. The prognosis is favorable with the normalization of wall motion abnormalities within weeks. We report a case of persistent apical ballooning complicated by an apical thrombus in Takotsubo cardiomyopathy of systemic lupus erythematous patient. Takotsubo cardiomyopathy may not be always transient and left ventricular thrombus can occur in the disease course as our patient.

Keyword

Takotsubo cardiomyopathy; Systemic lupus erythematosus; Persistent apical ballooning; Thrombus

MeSH Terms

Acute Coronary Syndrome
Coronary Angiography
Coronary Vessels
Female
Humans
Lupus Erythematosus, Systemic*
Prognosis
Takotsubo Cardiomyopathy*
Thrombosis*
Hydrazines

Figure

• 

  Fig. 1 Electrocardiography showing persistent ST segment elevation during the first admission (A) and 3 months follow-up (B).

• 

  Fig. 2 Initial echocardiography showing apical ballooning at diastole (A) and at systole (B) of apical 4 chamber view. Follow-up echocardiography showing a newly developed thrombus in the left ventricular apex 3 weeks later (C). Akinesia of the left ventricular apex was persistent but slightly improved. Follow-up echocardiography 3 months later showing persistent apical ballooning with resolution of the thrombus (D).

Reference

1. Yoshida T, Hibino T, Fujimaki T, Oguri M, Kato K, Yajima K, Ohte N, Yokoi K, Kimura G. Tako-tsubo cardiomyopathy complicated by apical thrombus formation: a case report. Int J Cardiol. 2009; 132:e120–e122.

2. Movahed MR, Donohue D. Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy. Cardiovasc Revasc Med. 2007; 8:289–292.

3. Donohue D, Movahed MR. Clinical characteristics, demographics and prognosis of transient left ventricular apical ballooning syndrome. Heart Fail Rev. 2005; 10:311–316.

4. Barcin C, Kursaklioglu H, Kose S, Amasyali B, Isik E. Takotsubo cardiomyopathy in a patient with Addison disease: is apical ballooning always reversible? Int J Cardiol. 2010; 138:e15–e17.

5. Tobar R, Rotzak R, Rozenman Y. Apical thrombus associated with Takotsubo cardiomyopathy in a young woman. Echocardiography. 2009; 26:575–580.

6. Ueda H, Hosokawa Y, Tsujii U, Miyawaki M, Mitsusada N, Yasuga Y, Hiraoka H, Nakatsuka S. An autopsy case of left ventricular apical ballooning probably caused by pheochromocytoma with persistent ST-segment elevation. Int J Cardiol. 2011; 149:e50–e52.

7. Lee PH, Song JK, Park IK, Sun BJ, Lee SG, Yim JH, Choi HO. Takotsubo cardiomyopathy: a case of persistent apical ballooning complicated by an apical mural thrombus. Korean J Intern Med. 2011; 26:455–459.

8. Wakabayashi K, Dohi T, Daida H. Takotsubo cardiomyopathy associated with epilepsy complicated with giant thrombus. Int J Cardiol. 2011; 148:e28–e30.

9. Kurisu S, Inoue I. Cardiac rupture in tako-tsubo cardiomyopathy with persistent ST-segment elevation. Int J Cardiol. 2012; 158:e5–e6.

10. Giugliano GR, Giugliano RP, Gibson CM, Kuntz RE. Meta-analysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol. 2003; 91:1055–1059.