Int J Cardiovasc Imaging DOI 10.1007/s10554-014-0469-x
IMAGES IN CV APPLICATIONS
Recurrent mid-ventricular takotsubo cardiomyopathy Ken Kato • Yoshiaki Sakai • Iwao Ishibashi Yoshio Kobayashi
•
Received: 20 May 2014 / Accepted: 9 June 2014 Ó Springer Science+Business Media Dordrecht 2014
A 65-year-old woman was admitted for acute chest pain after choking on water. Coronary angiography revealed no obstructive coronary artery disease. Left ventriculogram demonstrated mid-ventricular akinesis with basal and apical hyperkinesis (Fig. 1a, b, video 1). The next day, cardiovascular magnetic resonance (CMR) imaging was performed. CMR demonstrated myocardial edema in the area of left ventricular wall motion abnormality (Fig. 1c) and no late gadolinium enhancement. Left ventricular ejection fraction by CMR was 52 % (video 2, 3). Echocardiogram on day 5 demonstrated complete recovery of the wall motion abnormality. Angiotensin II receptor blocker and statin were initiated during hospitalization, but discontinued due to an unspecified cause after discharge. Follow-up CMR at 5 months revealed no myocardial edema. Left ventricular ejection fraction was 72 %. Three years later, she presented with chest pain after choking on water that was the same trigger of the previous
episode. Coronary angiography showed no obstructive coronary artery disease. Left ventriculogram demonstrated mid-ventricular akinesis that was nearly identical to the previous episode (Fig. 1d, e, video 4). CMR demonstrated myocardial edema (Fig. 1f) and no late gadolinium enhancement. Left ventricular ejection fraction was 54 % (video 5). She remained well after discharge with complete recovery of the wall motion abnormality. Repeated episode of mid-ventricular takotsubo cardiomyopathy is very rare. To our knowledge, this is the first report of recurrence of mid-ventricular takotsubo cardiomyopathy detected by serial left ventriculogram and cardiovascular magnetic resonance imaging. Acknowledgments This manuscript has no relationship with any grants, contracts, financial supports, or industries. Conflict of interest
None.
Electronic supplementary material The online version of this article (doi:10.1007/s10554-014-0469-x) contains supplementary material, which is available to authorized users. K. Kato (&) Y. Kobayashi Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan e-mail: [email protected] Y. Sakai I. Ishibashi Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
123
Int J Cardiovasc Imaging Fig. 1 Left ventriculogram (LVG) and cardiovascular magnetic resonance imaging (CMR). Top row shows midventricular ballooning on LVG (a, b), and myocardial edema matching the distribution of wall motion abnormality on CMR (c, arrows) in the first episode. Bottom row shows almost same findings in the recurrent episode (d, e, f)
123
IMAGES IN CV APPLICATIONS
Recurrent mid-ventricular takotsubo cardiomyopathy Ken Kato • Yoshiaki Sakai • Iwao Ishibashi Yoshio Kobayashi
•
Received: 20 May 2014 / Accepted: 9 June 2014 Ó Springer Science+Business Media Dordrecht 2014
A 65-year-old woman was admitted for acute chest pain after choking on water. Coronary angiography revealed no obstructive coronary artery disease. Left ventriculogram demonstrated mid-ventricular akinesis with basal and apical hyperkinesis (Fig. 1a, b, video 1). The next day, cardiovascular magnetic resonance (CMR) imaging was performed. CMR demonstrated myocardial edema in the area of left ventricular wall motion abnormality (Fig. 1c) and no late gadolinium enhancement. Left ventricular ejection fraction by CMR was 52 % (video 2, 3). Echocardiogram on day 5 demonstrated complete recovery of the wall motion abnormality. Angiotensin II receptor blocker and statin were initiated during hospitalization, but discontinued due to an unspecified cause after discharge. Follow-up CMR at 5 months revealed no myocardial edema. Left ventricular ejection fraction was 72 %. Three years later, she presented with chest pain after choking on water that was the same trigger of the previous
episode. Coronary angiography showed no obstructive coronary artery disease. Left ventriculogram demonstrated mid-ventricular akinesis that was nearly identical to the previous episode (Fig. 1d, e, video 4). CMR demonstrated myocardial edema (Fig. 1f) and no late gadolinium enhancement. Left ventricular ejection fraction was 54 % (video 5). She remained well after discharge with complete recovery of the wall motion abnormality. Repeated episode of mid-ventricular takotsubo cardiomyopathy is very rare. To our knowledge, this is the first report of recurrence of mid-ventricular takotsubo cardiomyopathy detected by serial left ventriculogram and cardiovascular magnetic resonance imaging. Acknowledgments This manuscript has no relationship with any grants, contracts, financial supports, or industries. Conflict of interest
None.
Electronic supplementary material The online version of this article (doi:10.1007/s10554-014-0469-x) contains supplementary material, which is available to authorized users. K. Kato (&) Y. Kobayashi Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan e-mail: [email protected] Y. Sakai I. Ishibashi Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
123
Int J Cardiovasc Imaging Fig. 1 Left ventriculogram (LVG) and cardiovascular magnetic resonance imaging (CMR). Top row shows midventricular ballooning on LVG (a, b), and myocardial edema matching the distribution of wall motion abnormality on CMR (c, arrows) in the first episode. Bottom row shows almost same findings in the recurrent episode (d, e, f)
123
