Letter to the editorPrompt resolution of an apical left ventricular thrombus in a patient with takotsubo cardiomyopathy
Introduction
Transient left ventricular (LV)-dysfunction characterized by apical ballooning akinesis and hypercontraction of the basal segments is referred to as takotsubo cardiomyopathy [1], [2]. Its clinical manifestation closely resembles that of acute myocardial infarction, including acute onset of chest pain and ST-elevation on the electrocardiogram. In contrast to acute myocardial infarction, patients with takotsubo cardiomyopathy exhibit normal coronary angiography and mild increased cardiac enzymes that are disproportionate to the extent of akinesia. The LV-dysfunction usually resolves without any specific treatment. Takotsubo cardiomyopathy has been reported to have an incidence of 0.2% of all cases undergoing diagnostic coronary angiography in western Europe. This disorder predominantly affects elderly women and has been associated with emotional stress and with chronic pulmonary disease as predisposing factors [3], [4]. However, the precise cause of takotsubo cardiomyopathy remains to be determined.
Section snippets
Case report
A 74-year-old woman was admitted to our emergency department due to first occurrence of chest pain. The ECG showed ST elevation in leads II, III, aVF, and V1 to V5 and troponin T on admission was 0.31 μg/l. Emergency coronary angiography showed normal epicardial coronary vessels. LV-angiography demonstrated the presence of severe apical ballooning akinesis associated with basal hypercontraction and the patient was suspected to have takotsubo cardiomyopathy. Echocardiography performed on day 3,
Discussion
This case demonstrates a potential early complication of takotsubo cardiomyopathy by the formation of an LV-thrombus in a patient without history of heart failure or coronary artery disease. The LV-thrombus was detected by both MRI and by echocardiography, and resolved promptly within 9 days without the administration of lytic therapy and without causing thromboembolic complications. Furthermore, the LV-apex showed reversible ballooning akinesis which could be accurately predicted by MRI.
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Cited by (24)
Takotsubo Syndrome and Embolic Events
2016, Heart Failure ClinicsCitation Excerpt :In the event of ventricular thrombus formation in a TTC patient, it is likely that this was present at the time of diagnosis. However, recent case reports have suggested the development of LV thrombus much later in the course of the disease.4,11,13,48,49 This pattern of presentation underscores the need for close follow-up with echocardiography and cardiac MRI.
Complications in the clinical course of tako-tsubo cardiomyopathy
2014, International Journal of CardiologyCitation Excerpt :In addition, patients with LV thrombi have a higher incidence of biventricular involvement which may facilitate thrombus formation due to a larger area of stunned myocardium. Although prompt resolution of LV thrombi within 14 days has been described [34,35], our results show that despite therapeutic anticoagulation LV thrombi may grow and embolize, resulting in disabling stroke. Despite a large number of sometimes dramatic complications during the first days the mortality in our registry was low (2.5%).
Cardioembolic outcomes in stress-related cardiomyopathy complicated by ventricular thrombus: A systematic review of 26 clinical studies
2010, International Journal of CardiologyCitation Excerpt :Demographic and clinical characteristics of patients, methods used for making diagnosis of both SRC and LVT, as well as morphological data on LVT, were carefully analyzed. Three more studies did not fulfil the above inclusion criteria, so 26 studies only (n = 36 patients) were finally encountered for this systematic review [9–34] (Fig. 1). An interesting study describing a suspected case of Takotsubo cardiomyopathy complicated by biventricular thrombus was excluded for language restriction [35].
Thromboembolism in Takotsubo cardiomyopathy
2010, International Journal of CardiologySystemic embolism in takotsubo syndrome
2009, International Journal of CardiologyTako-tsubo cardiomyopathy complicated by apical thrombus formation: A case report
2009, International Journal of Cardiology