Korean Circ J.  2013 Dec;43(12):834-838. 10.4070/kcj.2013.43.12.834.

Inverted-Takotsubo Cardiomyopathy in a Patient with Pulmonary Embolism

• Lee SH
• Kim DH
• Jung MS
• Lee JW
• Nam KM
• Cho YS
• Jeong JH

• KMID: 2224779
• DOI: http://doi.org/10.4070/kcj.2013.43.12.834

Abstract

As the use of early coronary angiography and echocardiography become widely available in the setting of acute coronary syndrome, the gradual increase for variant forms of transient left ventricular (LV) apical ballooning syndrome have been recognized. This syndrome usually occurs in women and is frequently elicited by an intense emotional, psychological, and physical event. While the patients' characteristics between typical and non-typical LV ballooning syndrome seem to differ, the presentation, clinical features, and reversibility of LV wall motion abnormalities are similar. We present a middle-aged woman who experienced inverted takotsubo cardiomyopathy triggered by pulmonary embolism. To the best of our knowledge, this case is particularly unique and is rarely reported in the disease entity.

Keyword

Stress cardiomyopathy; Takotsubo cardiomyopathy; Pulmonary embolism

MeSH Terms

Acute Coronary Syndrome
Cardiomyopathies*
Coronary Angiography
Echocardiography
Female
Humans
Pulmonary Embolism*
Takotsubo Cardiomyopathy

Figure

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  Fig. 1 Electrocardiogram on admission.

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  Fig. 2 Computed tomography in a 38-year-old woman with pulmonary embolism. A: this shows an intraluminal filling defect in the right lower lobe pulmonary artery (arrow). B: the clot is also visible in anterior and posterior basal segment arteries (arrows).

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  Fig. 3 Transthoracic echocardiography at the time of pulmonary embolism shows severe left ventricular systolic dysfunction with hypokinesia of the base and mid ventricular segment and hypercontractility of the apex. A and B: parasternal long-axis view in diastole and systole. C and D: apical four-chamber view in diastole and systole.

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  Fig. 4 A follow-up echocardiography 1 week later shows improved base and mid portions of ventricle and nearly normalized cardiac functions. A and B: parasternal long-axis view in diastole and systole. C and D: apical four-chamber view in diastole and systole.

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