Chest pain and dyspnea, which started shortly after her close friend died (on the same day).
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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 enhancement 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, coronary angiography was also performed and all the coronary arteries were in excellent condition.
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 contraction 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 cardiomyopathy.
- Fernández-Pérez GC, Aguilar-Arjona JA, de la Fuente GT et-al. Takotsubo cardiomyopathy: assessment with cardiac MRI. AJR Am J Roentgenol. 2010;195 (2): W139-45. doi:10.2214/AJR.09.3369 - Pubmed citation
- Akashi YJ, Goldstein DS, Barbaro G et-al. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008;118 (25): 2754-62. Circulation (full text) - doi:10.1161/CIRCULATIONAHA.108.767012 - Pubmed citation