Prolonged ST-Segment Elevation and Persistent Left Ventricular Dysfunction Assessed by Dual-Isotope Myocardial Scintigraphy in Takotsubo Syndrome: A Case Report

Figures

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  Figure 1. Serial chest radiographs. Initial chest radiography shows cardiomegaly and pulmonary congestion, together with rightward deviation of the trachea, presumably due to a thyroid tumor (A). Follow-up chest radiography on hospital day 20 demonstrates marked improvement in pulmonary congestion (B).

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  Figure 2. Initial electrocardiogram. Initial electrocardiogram showed right bundle branch block and marked ST-segment elevation with terminal T-wave inversion in leads V3–V6 (arrows), with a maximum ST-segment elevation of 3 mm in lead V4. Subtle ST-segment elevation less than 1 mm was also noted in the limb leads (I, II, III, -aVR, aVF), which was considered significant relative to the QRS amplitude. The corrected QT interval was prolonged at 494 ms.

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  Figure 3. Serial echocardiographic images. Transthoracic echocardiography demonstrates extensive akinesis of the left ventricular (LV) apical segments, extending beyond the territory of a single coronary artery, with an ejection fraction of 35% (A and B, arrows). Follow-up echocardiography was performed weekly, demonstrating no significant recovery of LV wall motion throughout the hospital course (C-F, arrows). The LV ejection fraction remained between 35% and 40% during the hospital course, with no significant improvement.

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  Figure 4. Coronary angiograms. Coronary angiography of the left (A) and right (B) coronary arteries was performed one week after admission, revealing no significant coronary artery stenosis. LAD: left anterior descending coronary artery; LCX: left circumflex coronary artery; RCA: right coronary artery

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  Figure 5. Serial electrocardiograms. Serial electrocardiograms demonstrated prolonged ST-segment elevation persisting through hospital day 20, which resolved by day 27 (arrows). T-wave inversion was also observed in both limb and precordial leads, with a maximum negative amplitude of 7 mm in leads V3 and V4.

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  Figure 6. Dual-isotope myocardial scintigraphic images. Dual-isotope myocardial scintigraphy using 201Tl and 123I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) demonstrates a marked perfusion–metabolism mismatch, with moderately reduced 201Tl uptake and severely reduced 123I-BMIPP uptake in the dysfunctional segments.