Korean J Intern Med.  2011 Dec;26(4):455-459. 10.3904/kjim.2011.26.4.455.

Takotsubo Cardiomyopathy: A Case of Persistent Apical Ballooning Complicated by an Apical Mural Thrombus

• Lee PH
• Song JK
• Park IK
• Sun BJ
• Lee SG
• Yim JH
• Choi HO

• KMID: 1729249
• DOI: http://doi.org/10.3904/kjim.2011.26.4.455

Abstract

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.

Keyword

Takotsubo cardiomyopathy; Persistent apical ballooning; Thrombus

MeSH Terms

Adrenergic beta-Antagonists/therapeutic use
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Catecholamines/blood
Chest Pain
Diuretics/therapeutic use
Female
Humans
Middle Aged
Takotsubo Cardiomyopathy/*diagnosis/drug therapy/pathology
Thrombosis
Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology