Left Ventricular Rupture Associated With Takotsubo Cardiomyopathy

Abstract

A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with takotsubo cardiomyopathy. We suggest that takotsubo cardiomyopathy may be a newly recognized cause of sudden cardiac death.

Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis

“…9 The prognosis of TC is generally favourable, although fatal cases have been reported due to ventricular free-wall rupture. 11 Recurrence has been reported as high as 11%. 12,13 We hypothesize that TC was triggered in our patient by compromise of tracheal air flow induced by the goiter.…”

Associação rara entre lúpus eritematoso sistêmico, obesidade mórbida e Síndrome de Takotsubo

“…Notwithstanding the apparent benign manifestation of this process, authors eventually mention clinical evolution with acute pulmonary edema, cardiogenic shock, ventricular rupture and death 7 . High concentrations of plasma noradrenaline seem to indicate the possibility of the participation of altered catecholamine dynamics 8 .…”

Takotsubo-like Transient Biventricular Dysfunction with Pressure Gradients

“…In Japan, this asynergy has been widely called takotsubo-like left ventricular dysfunction (1)(2)(3)(4)(5)(6)(7)(8)(9), and this syndrome is gradually being established worldwide (10)(11)(12)(13)(14)(15)(16)(17). Major clinical characteristics are that (1) most patients are elderly women; (2) the symptoms are similar to those of acute myocardial infarction; (3) takotsubo-like left ventricular dysfunction, which extends over more than one coronary artery region, is transient and dramatically resolves within several weeks.…”

“…To date, we have reported several early angiographic characteristics of takotsubo syndrome such as left ventricular outflow tract obstruction (2), mitral regurgitation (2), apical thrombus formation (3) or reduced coronary blood flow (2). Also, other Japanese groups have recently reported malignant arrhythmia (8) or cardiac rupture (9) as complications of takotsubo syndrome.…”

“…Takotsubo syndrome is characterized by transient left ventricular apical wall motion abnormality with electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction, but without significant coronary artery disease (1)(2)(3)(4)(5)(6)(7)(8)(9). To date, we have reported several early angiographic characteristics of takotsubo syndrome such as left ventricular outflow tract obstruction (2), mitral regurgitation (2), apical thrombus formation (3) or reduced coronary blood flow (2).…”