Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 63, No. 2, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.07.112
IMAGES IN CARDIOLOGY
Recurrent Takotsubo Cardiomyopathy With Variable Left Ventricular Obstruction and Morphologies Seiji Kano, MD,* Ryo Munakata, MD,* Toru Inami, MD,* Masamichi Takano, MD,* Yoshihiko Seino, MD, PHD,* Wataru Shimizu, MD, PHDy Chiba and Tokyo, Japan
From the *Department of Cardiology, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan; and the yDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. Manuscript received July 16, 2013; accepted July 30, 2013.
60-year-old woman presenting with chest pain with elevated troponin T had different patterns of electrocardiogram and left ventricular (LV) morphologies associated with Takotsubo cardiomyopathy. Each coronary angiography was revealed to be essentially normal. The first episode demonstrated midventricular ballooning with hypercontractile apex and base (A, Online Video 1) and nonspecific ST-T changes (B). Left ventricular obstruction was documented after Valsalva maneuver (C). Eighteen months later, the second episode showed typical apical ballooning (D, Online Video 2) with inverted T-wave (E) and no LV obstruction. Both episodes followed emotional stress. Variability of beta-adrenergic receptor sensitivity might associate with recurrent cardiomyopathy with different LV obstruction and morphologies.
A
Vol. 63, No. 2, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.07.112
IMAGES IN CARDIOLOGY
Recurrent Takotsubo Cardiomyopathy With Variable Left Ventricular Obstruction and Morphologies Seiji Kano, MD,* Ryo Munakata, MD,* Toru Inami, MD,* Masamichi Takano, MD,* Yoshihiko Seino, MD, PHD,* Wataru Shimizu, MD, PHDy Chiba and Tokyo, Japan
From the *Department of Cardiology, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan; and the yDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. Manuscript received July 16, 2013; accepted July 30, 2013.
60-year-old woman presenting with chest pain with elevated troponin T had different patterns of electrocardiogram and left ventricular (LV) morphologies associated with Takotsubo cardiomyopathy. Each coronary angiography was revealed to be essentially normal. The first episode demonstrated midventricular ballooning with hypercontractile apex and base (A, Online Video 1) and nonspecific ST-T changes (B). Left ventricular obstruction was documented after Valsalva maneuver (C). Eighteen months later, the second episode showed typical apical ballooning (D, Online Video 2) with inverted T-wave (E) and no LV obstruction. Both episodes followed emotional stress. Variability of beta-adrenergic receptor sensitivity might associate with recurrent cardiomyopathy with different LV obstruction and morphologies.
A
