Takotsubo cardiomyopathy (echocardiography)

Case contributed by Dr Yune Kwong

Presentation

Cardiac arrest during invasive procedure (under sedation).

Patient Data

Age: 60 years old
Gender: Female

Bedside echo performed in ICU.

Modality: Ultrasound

Echocardiography demonstrates severe hypokinesis and ballooning of the apical segments of the left ventricle (arrows). Ejection fraction severely reduced, visually estimated at 30%.

Echo performed 3 weeks later

Modality: Ultrasound

With supportive therapy, the patient made good clinical recovery. Follow-up echocardiography shows improved left ventricular apical contractility, with good ejection fraction, visually assessed as low-normal (about 50%).

Case Discussion

Hypokinesis and ballooning of the left ventricular apical segments is consistent with Takotsubo cardiomyopathy. This is especially so, considering the spontaneous recovery of myocardial function. Takotsubo cardiomyopathy occurs most commonly in post-menopausal women, following a stressful event (emotional or physical).

Echocardiography has the advantage of portability and is ideal in acutely ill patients. In selected patients, cardiac MRI is advantageous as good visualisation of the apex is provided (the apex can be difficult to visualise on echo). Cardiac MRI also allows exclusion of alternative causes of dyskinesis eg myocardial infarction or myocarditis.

PlayAdd to Share

Case Information

rID: 29997
Case created: 10th Jul 2014
Last edited: 14th Mar 2016
System: Cardiac
Inclusion in quiz mode: Excluded

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.