Transient Left Ventricular Outflow Tract Obstruction in an Elderly Patient Admitted with Takotsubo

Figures

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  Figure 1. Electrocardiogram upon presentation. It showed sinus rhythm with a heart rate of around 68 beats per minute and clear ST-segment elevation in anterior leads (V2 to V5) accompanied by T wave inversion in leads V3 to V6

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  Figure 2. Coronary angiogram in right anterior oblique cranial view; it displayed proximal left anterior descending artery 40%–50% lesion that was deemed to be insignificant with intravascular ultrasound assessment (minimal cross-sectional area = 4.8 mm2)

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  Figure 3. (a) Transthoracic echocardiography (TTE). Apical four-chamber view revealing akinetic and aneurysmal apex with hyperkinesia in basal segments that gives typical picture of apical ballooning syndrome. (b) TTE. Apical five-chamber color flow doppler in the left ventricular outflow tract (LVOT) area displays color aliasing and disturbance of the flow which indicates high gradient in the area. (c) Continuous wave doppler across LVOT in apical three-chamber view. It showed a significant LVOT gradient of 70 mmHg at rest

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  Figure 4. (a) Transthoracic echocardiography (TTE). Apical four-chamber view reveals normally contracting left ventricular apex and the resolution of apical segments dilatation. (b) TTE. Apical five-chamber view with continuous wave doppler along the left ventricular outflow tract (LVOT) area. It shows the resolution of LVOT gradient even with the Valsalva maneuver

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  Figure 5. Transthoracic echocardiography (TTE). TTE Parasternal long axis view revealing acute aortoseptal angle (around 80°) with the sigmoid shape of basal anteroseptal segment