International Journal of Cardiology 184 (2015) 267
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
A fourth form of left ventricular involvement in takotsubo cardiomyopathy Stefan Peters ⁎ St. Elisabeth Hospital gGmbH Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 3 January 2015 Accepted 21 February 2015 Available online 24 February 2015 Keywords: Takotsubo cardiomyopathy Inferoapical dyskinesia Apical ballooning Mid-ventricular ballooning
In takotsubo cardiomyopathy three forms of left ventricular involvement are described: apical ballooning (85%), mid-ventricular ballooning (14%) and basal ballooning, that accounts for only 1% [1]. A case report is described where the patient presented a fourth form of left ventricular abnormality. A 72 year-old female patient was admitted to hospital with signs of heart failure. At night she suffered from gasping, was resuscitated with controlled ventilation. Her husband had carotid surgery and some lifethreatening complications but survived a month ago. On her ECG she was in sinus rhythm and had ST elevation in V1 to V3, laboratory findings was normal with isolated troponin rise. Chest x-ray revealed cranialization of pulmonary vessels and a left-sided pleural effusion. At echocardiography left ventricle was within normal range and left ventricular function was reduced by apical dyskinesia. At once coronary angiography and left ventricular angiography were performed. Coronary angiography was normal and left ventricular angiography revealed inferoapical dyskinesia. The anteroapical contraction was hypokinetic and anteromedial contraction was normal, not fulfilling true apical ballooning. Left ventricular involvement, too, does not fulfill true mid-ventricular ballooning as inferoapical region was dyskinetic and anteromedial segments contract normally.
⁎ Cardiology, St. Elisabeth Hospital gGmbH Salzgitter, Liebenhaller Str. 20, 38259 Salzgitter, Germany. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.02.040 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
In conclusion, the patient fulfills anamnestic and clinical signs of takotsubo cardiomyopathy while the left ventricular contraction impairment does not fulfill apical or mid-ventricular ballooning. For all we know a new left ventricular involvement term in takotsubo cardiomyopathy is born — inferoapical ballooning.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest. (See Fig. 1.)
Fig. 1. Left ventricular angiography of this patient: inferoapical ballooning (dyskinesia).
Reference [1] S.W. Sharkey, B.J. Maron, Epidemiology and clinical profile of Takotsubo cardiomyopathy, Circ. J. 78 (2014) 2119–2128.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
A fourth form of left ventricular involvement in takotsubo cardiomyopathy Stefan Peters ⁎ St. Elisabeth Hospital gGmbH Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 3 January 2015 Accepted 21 February 2015 Available online 24 February 2015 Keywords: Takotsubo cardiomyopathy Inferoapical dyskinesia Apical ballooning Mid-ventricular ballooning
In takotsubo cardiomyopathy three forms of left ventricular involvement are described: apical ballooning (85%), mid-ventricular ballooning (14%) and basal ballooning, that accounts for only 1% [1]. A case report is described where the patient presented a fourth form of left ventricular abnormality. A 72 year-old female patient was admitted to hospital with signs of heart failure. At night she suffered from gasping, was resuscitated with controlled ventilation. Her husband had carotid surgery and some lifethreatening complications but survived a month ago. On her ECG she was in sinus rhythm and had ST elevation in V1 to V3, laboratory findings was normal with isolated troponin rise. Chest x-ray revealed cranialization of pulmonary vessels and a left-sided pleural effusion. At echocardiography left ventricle was within normal range and left ventricular function was reduced by apical dyskinesia. At once coronary angiography and left ventricular angiography were performed. Coronary angiography was normal and left ventricular angiography revealed inferoapical dyskinesia. The anteroapical contraction was hypokinetic and anteromedial contraction was normal, not fulfilling true apical ballooning. Left ventricular involvement, too, does not fulfill true mid-ventricular ballooning as inferoapical region was dyskinetic and anteromedial segments contract normally.
⁎ Cardiology, St. Elisabeth Hospital gGmbH Salzgitter, Liebenhaller Str. 20, 38259 Salzgitter, Germany. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.02.040 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
In conclusion, the patient fulfills anamnestic and clinical signs of takotsubo cardiomyopathy while the left ventricular contraction impairment does not fulfill apical or mid-ventricular ballooning. For all we know a new left ventricular involvement term in takotsubo cardiomyopathy is born — inferoapical ballooning.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest. (See Fig. 1.)
Fig. 1. Left ventricular angiography of this patient: inferoapical ballooning (dyskinesia).
Reference [1] S.W. Sharkey, B.J. Maron, Epidemiology and clinical profile of Takotsubo cardiomyopathy, Circ. J. 78 (2014) 2119–2128.
