Bedside echocardiography rapidly identified a fatal ventricular free wall rupture in an 84-year-old man with Takotsubo syndrome triggered by an acute ischemic stroke.
Case Report (n=1)
No
Echocardiography is a crucial bedside tool for the rapid detection of fatal mechanical complications like ventricular free wall rupture in patients with Takotsubo syndrome triggered by acute ischemic stroke.
Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy, is generally considered a reversible condition; however, it can be associated with fatal complications. We report a case of ventricular free wall rupture diagnosed by echocardiography in TTS triggered by an acute ischemic stroke. An 84-year-old man presented with left hemiparesis and was diagnosed with an acute right parietal infarction. On hospital day six, electrocardiography revealed diffuse ST-segment elevation without chest pain. Transthoracic echocardiography demonstrated akinesis of the mid-to-apical segments of the left ventricle with compensatory hyperkinesis of the basal segments, resulting in a typical apical ballooning pattern. These findings were inconsistent with a single coronary artery territory and supported the diagnosis of TTS. Coronary angiography revealed moderate coronary stenoses; however, left ventriculography demonstrated wall motion abnormalities that did not correspond to a single coronary distribution, further supporting the diagnosis of TTS. Several hours later, the patient developed sudden cardiac arrest. Transthoracic echocardiography revealed pericardial effusion with fibrin-like echoes, suggestive of ventricular free wall rupture. Despite resuscitative efforts, the patient died.
Akihiro Mizuno (Mon,) conducted a case report in Takotsubo syndrome complicated by ventricular free wall rupture (n=1). Bedside echocardiography rapidly identified a fatal ventricular free wall rupture in an 84-year-old man with Takotsubo syndrome triggered by an acute ischemic stroke.