Korean Circ J.  2009 Jan;39(1):37-41. 10.4070/kcj.2009.39.1.37.

Tako-Tsubo Cardiomyopathy by Transient Dynamic Left Midventricular Obstruction

• Hong KW
• Park DG
• Choi HH
• Kim SE
• Yoon DH
• Lee JH
• Han KR
• Oh DJ

• KMID: 1769512
• DOI: http://doi.org/10.4070/kcj.2009.39.1.37

Abstract

A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy.

Keyword

Tako-tsubo cardiomyopathy; Ventricular outflow obstruction; Echocardiography, stress

MeSH Terms

Coronary Angiography
Coronary Vessels
Diabetes Mellitus
Dobutamine
Echocardiography
Echocardiography, Stress
Emergencies
Female
Follow-Up Studies
Humans
Hypertension
Hypovolemia
Middle Aged
Shock
Takotsubo Cardiomyopathy
Urinary Tract Infections
Ventricular Outflow Obstruction
Dobutamine

Figure

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  Fig. 1 Change of electrocardiographic finding over the course. A: electrocardiography on admission, showing ST-segment elevation with Q waves in V1-V4, I, and aVL. B: electrocardiography 3 months before admission, showing left ventricular hypertrophy. C: electrocardiography on day 28, showing T wave inversion in V2-6.

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  Fig. 2 Initial echocardiography on admission. A: end-systolic echocardiogram, showing left ventricular apical ballooning. B: end-diastolic echocardiogram, showing flow acceleration in the left ventricular outflow tract. C: continuous wave Doppler ultrasound showing a left ventricular outflow tract pressure gradient of 109 mmHg.

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  Fig. 3 Echocardiography on day 5, showing systolic anterior motion of the mitral valve (arrow).

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  Fig. 4 Dobutamine stress echocardiography on day 28. A: baseline echocardiography. B: at the peak dose, a dynamic left ventricular mid-cavity obstruction with a pressure gradient of 158 mmHg was induced. This gradient resolved during the recovery period.

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