Takotsubo Cardiomyopathy-Induced Cardiac Free Wall Rupture: A Case Report and Review of Literature

Abstract

Takotsubo cardiomyopathy (TCM) is an acquired form of cardiomyopathy that is commonly seen among post-menopausal women. It is characterized by left ventricular apical ballooning, electrocardiographic changes and mild elevation of cardiac enzymes in the absence of significant coronary artery stenosis. TCM usually has benign course. However, on rare instance, it can result in life-threatening and fatal complications including acute cardiogenic shock, ventricular arrhythmias and ventricular wall rupture. We herein report a case of a 77-year-old female who developed TCM complicated with massive pericardial effusion and cardiac arrest. The patient died and autopsy revealed normal coronaries with a slit-like rupture on the antero-apical surface of the heart extending into the papillary muscle. The clinical course, labs and angiographic findings preceding the cardiac rupture will be outlined. A thorough literature review including review of 14 previously reported case reports of TCM complicated with cardiac rupture will be included.

Update of takotsubo syndrome in the era of COVID-19

“…A very rare but critical complication is left ventricular free wall or septal rupture [ [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. Persistent ST elevation may be a high-risk electrocardiographic finding for left ventricular rupture [ 57 ].…”

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 ].…”

Another typical ST-segment elevation myocardial infarction in the elderly?

“…The patient’s clinical profile, symptoms, mild troponin elevation and ECG findings (aVR ST segment depression, anterolateral ST segment elevation), in the absence of occlusive coronary disease but LAD spasm, suggested the diagnosis of takotsubo cardiomyopathy 2–4. The later cardiogenic shock and picture (figure 2) were explained by the apical wall rupture 1…”