Takotsubo cardiomyopathy

Case contributed by Dr Gregor Savli

Presentation

68 old female presented with stenocardia and dyspnoea, which started shortly after her close friend died (on the same day).

Patient Data

Age: 70
Gender: Female
Modality: MRI

There is normal myocardial contraction only in the basal segments (AHA 1 to 6).
Hypokinesia of posteroseptal wall (AHA 8 to 10) and basically akinesia or very little movement of anteroseptal wall and apical segments (AHA 7 and 11 to 17).

This MRI was performed on the 5th day from the onset of symptoms. No perfusion deficits, edema or late enhacement was seen on perfusion, T2 BB fatsat and late enhancement (with nulled myocardium) sequences.

LV ejection fraction was 22%. EDV 136 ml, ESV 106 ml, SV 30 ml.

1 day after MRI, coronarography was also performed and all the coronary arteries were in excellent condition.

Case Discussion

The findings are fairly typical for takotsubo CMP. Akinetic, "stunned" myocardium does not follow a vascular territory, instead, it follows LV anatomy - it contracts normally at the base with no contaction  at the apex of LV. This results in a typical LV shape, named after the appearance  of  a Japanese octopus trap.

There were no signs of myocardial infarction (edema and/or late enhancement). The coronary arteries were in excellent, "mint" condition.

These findings, combined with the typical history of a very stressful moment or circumstances are typical for takotsubo CMP.

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Case Information

rID: 25090
Case created: 4th Oct 2013
Last edited: 7th Dec 2016
System: Cardiac
Inclusion in quiz mode: Included

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