J Cardiovasc Ultrasound.  2015 Sep;23(3):173-176. 10.4250/jcu.2015.23.3.173.

Ventricular Septal Rupture in a Case Suspected as Stress Induced Cardiomyopathy

• Rhyou HI
• Park TH
• Han JE
• Kim MH
• Kim YD

• KMID: 2068727
• DOI: http://doi.org/10.4250/jcu.2015.23.3.173

Abstract

An 87-year-old woman with continuous chest discomfort was referred to our hospital. ST-segment elevation in lead V1-4 was detected on electrocardiography and ventricular septal rupture (VSR) was observed on echocardiography. Post-acute myocardial infarction (AMI) VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography showed normal coronary artery. On the fourth day after admission, the patient died. We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

Keyword

Ventricular septal rupture; Stress induced cardiomyopathy; Acute myocardial infarction

MeSH Terms

Aged, 80 and over
Cardiac Catheterization
Cardiac Catheters
Cardiomyopathies*
Coronary Angiography
Coronary Vessels
Echocardiography
Electrocardiography
Emergencies
Female
Humans
Myocardial Infarction
Thorax
Ventricular Septal Rupture*

Figure

• 

  Fig. 1 Electrocardiogram on admission (A), on the third day after admission (B), and on the fourth day after admission (C and D).

• 

  Fig. 2 Echocardiography shows akinetic apical segments on end-diastole (A) and end-systole (B), shunt flow from left to right at apical septum (C), and ventricular septal defect (arrow) (D). LV: left ventricle, RV: right ventricle.

• 

  Fig. 3 Coronary angiography demonstrates no stenotic lesion in left (A) and right coronary artery (B).

Reference

1. Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation. 2007; 115:e56–e59.

2. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006; 27:1523–1529.

3. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008; 118:2754–2762.

4. Ohara Y, Hiasa Y, Hosokawa S, Tomokane T, Yamaguchi K, Ogura R, Miyajima H, Ogata T, Yuba K, Suzuki N, Takahashi T, Kishi K, Ohtani R. Left ventricular free wall rupture in transient left ventricular apical ballooning. Circ J. 2005; 69:621–623.

5. Kumar S, Kaushik S, Nautiyal A, Choudhary SK, Kayastha BL, Mostow N, Lazar JM. Cardiac rupture in takotsubo cardiomyopathy: a systematic review. Clin Cardiol. 2011; 34:672–676.

6. Virani SS, Khan AN, Mendoza CE, Ferreira AC, de Marchena E. Takotsubo cardiomyopathy, or broken-heart syndrome. Tex Heart Inst J. 2007; 34:76–79.

7. Sacha J, Maselko J, Wester A, Szudrowicz Z, Pluta W. Left ventricular apical rupture caused by takotsubo cardiomyopathy--comprehensive pathological heart investigation. Circ J. 2007; 71:982–985.

8. Izumi K, Tada S, Yamada T. A case of Takotsubo cardiomyopathy complicated by ventricular septal perforation. Circ J. 2008; 72:1540–1543.

9. Lee JW, Kim JY, Youn YJ, Sung JK, Lee NS, Lee KH, Yoo BS, Lee SH, Yoon J, Choe KH. Clinical characteristics and prognostic factors of stress-induced cardiomyopathy. Korean Circ J. 2010; 40:277–282.