Presentation
Cardiac arrest during invasive procedure (under sedation).
Patient Data
Bedside echo performed in ICU.
Echocardiography demonstrates severe hypokinesis and ballooning of the apical segments of the left ventricle (arrows). Ejection fraction severely reduced, visually estimated at 30%.
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 visualization of the apex is provided (the apex can be difficult to visualize on echo). Cardiac MRI also allows exclusion of alternative causes of dyskinesis eg myocardial infarction or myocarditis.
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