Transient apical ballooning complicated with left ventricular thrombus and repeated embolic events with fatal outcome despite anticoagulant therapy

Porta, Andreu; Barrabés, José A.; Figueras, Jaume; Millán, Xavier; Sambola, Antonia; Boyé, Rosa; Garcı́a-Dorado, David

doi:10.1016/j.ijcard.2012.09.154

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…A recent case repot describes a 88 years old female with biventricular TCM complicated by biventricular thrombosis [23]. A thrombus attached to the septo-apical wall [24], a thrombus attached to the apical inferior wall by a thin stalk [25], a thrombus attached to an akinetic segment of the anterior and anteroseptal wall, a mobile thrombus adjacent to the anterolateral papillary muscle [8], a mobile thrombus adjacent to the posteromedial papillary muscle [8], two mobile thrombi in the left ventricular apex [8] and multiple thrombotic masses in the left ventricular apex [26] were also described.…”

Section: Discussionmentioning

confidence: 99%

“…Out of the 49 cases we summarized, 8 cases had isolated cerebral thromboemboli, one case had an isolated renal infarct [17], one case had multifocal micro infarctions in the brain, spleen and kidneys [27] and one case had cerebral and superior mesenteric artery thromboembolism [24] (Table 1). The management of TCM with ventricular thrombus is directed to prevent embolic episodes and in most cases heparin and warfarin were used for anticoagulation (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Serial TTE was performed for the majority of cases to confirm thrombus resolution. We could find only one case report describing repeated embolic events despite anticoagulation with subcutaneous enoxaparin and aspirin treatment [24]. Myocardial necrosis and cardiac rupture [29], massive hemorrhagic effusion following ventricular wall rupture [30], large cerebral infarct with mass effect and hemorrhagic transformation [31] can complicate the medical management.…”

Section: Discussionmentioning

confidence: 99%

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Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Herath

Pahalagamage

Lindsay

et al. 2017

BMC Cardiovasc Disord

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BackgroundTakotsubo cardiomyopathy is characterized by transient systolic dysfunction of the apical and mid segments of the left ventricle in the absence of obstructive coronary artery disease. Intraventricular thrombus formation is a rare complication of Takotsubo cardiomyopathy and current data almost exclusively consists of isolated case reports and a few case series. Here we describe a case of Takotsubo cardiomyopathy with formation of an apical thrombus within 24 h of symptom onset, which has been reported in the literature only once previously, to the best of our knowledge. We have reviewed the available literature that may aid clinicians in their approach to the condition, since no published guidelines are available.Case presentationA 68-year-old Sri Lankan female presented to a local hospital with chest pain. Electrocardiogram (ECG) showed ST elevation, and antiplatelets, intravenous streptokinase and a high dose statin were administered. Despite this ST elevation persisted; however the coronary angiogram was negative for obstructive coronary artery disease. Echocardiogram revealed hypokinesia of the mid and apical segments of the left ventricle with typical apical ballooning and a sizable apical thrombus. She had recently had a viral infection and was also emotionally distressed as her sister was recently diagnosed with a terminal cancer. A diagnosis of Takotsubo cardiomyopathy was made and anticoagulation was started with heparin and warfarin. The follow up echocardiogram performed 1 week later revealed a small persistent thrombus, which had completely resolved at 3 weeks.ConclusionThough severe systolic dysfunction is observed in almost all the patients with Takotsubo cardiomyopathy, intraventricular thrombus formation on the first day of the illness is rare. The possibility of underdiagnosis of thrombus can be prevented by early echocardiogram in Takotsubo cardiomyopathy. The majority of reports found in the literature review were of cases that had formed an intraventriclar thrombus within the first 2 weeks, emphasizing the importance of follow up echocardiography at least 2 weeks later. The management of a left ventricular thrombus in Takotsubo cardiomyopathy is controversial and in most cases warfarin and heparin were used for a short duration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0616-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Herath

Pahalagamage

Lindsay

et al. 2017

BMC Cardiovasc Disord

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Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy

et al. 2015

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Left ventricular (LV) apical thrombus can rarely occur during the early phase of takotsubo cardiomyopathy. We report such a case that was depicted clearly in contrast computed tomography (CT) but not in initial echocardiography. Because LV thrombus may lead to thromboembolic events, we should evaluate all patients with takotsubo cardiomyopathy for the presence of a LV thrombus. LV thrombus is generally recognized with echocardiography in the course of follow-up, but limited depiction of the LV apex with echocardiography can make evaluation of LV thrombus difficult. Contrast CT is useful to detect LV apical thrombus associated with takotsubo cardiomyopathy.

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Differential diagnosis of the association of gastrointestinal symptoms and ST segment elevation, in the absence of chest pain

Jolobe

2021

The American Journal of Emergency Medicine

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Transient apical ballooning complicated with left ventricular thrombus and repeated embolic events with fatal outcome despite anticoagulant therapy

Cited by 8 publications

References 6 publications

Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy

Differential diagnosis of the association of gastrointestinal symptoms and ST segment elevation, in the absence of chest pain

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