Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

Abstract

Objective:We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium.Methods:The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago.Results:Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function.Conclusion:Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE)

“…LV free wall or interventricular septum rupture is a very rare (<1%) life-threatening complication burdened by high mortality rates due to cardiogenic shock and/or cardiac tamponade. In the presence of clear haemodynamic instability, prompt echocardiographic detection of this complication is important to favour rapid referral for surgery [ 59 , 60 ].…”

Atypical Takotsubo Cardiomyopathy With Persistent Left Ventricular Aneurysm After Cardiac Surgery

“…Typical Takotsubo cardiomyopathy is a cardiac syndrome characterized by reversible left ventricular dysfunction and left ventricular apical ballooning deformity with clinical symptoms and signs similar to acute coronary syndrome but with a negative coronary angiography (CAG). It predominantly has been observed in woman older than 60 years of age, often is triggered by emotional or physical stress, and associated with sympathetic stimulation mediated by excessive plasma catecholamine levels [Kudaiberdiev 2017]. Generally, patients with Takotsubo cardiomyopathy have a favorable prognosis because the wall motion abnormality returns to normal within several days to weeks without severe complication.…”

A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma

“…The precise etiology of TCC/r-TCC is unknown, but evidence indicates that both patterns are associated with strong surges of adrenergic outflow that occur following intense emotional or physical stress [5–9], where high circulating levels of epinephrine may cause coronary spasm, endothelial dysfunction, and indirect myocardial damage [2]. A few case studies have suggested a potential connection between r-TTC and neurological insults as inciting factors.…”