Key result
Severe stroke from massive apical thrombus in Takotsubo cardiomyopathy highlights the dilemma of initiating anticoagulation.
Why the study?
Managing left ventricular thrombus complicating takotsubo cardiomyopathy alongside a severe ischemic stroke creates a clinical dilemma regarding the timing of anticoagulation initiation.
Case Report (n=1)
This case highlights the severe clinical dilemma and high mortality associated with managing a massive LV thrombus in Takotsubo cardiomyopathy when complicated by an acute severe ischemic stroke.
Should not yet change anticoagulation practice in Takotsubo cardiomyopathy; leaves optimal strategy open for prospective study.
Takotsubo cardiomyopathy or stress cardiomyopathy is a condition characterized by acute and transient left ventricular systolic dysfunction in the absence of coronary heart disease, occurring after an acute emotional or physical stressful event. Cardiac dysfunction in these patients is suspected to be secondary to catecholamine induced cardiac myocyte injury via cyclic AMP-mediated calcium overload or due to endothelial dysfunction. Even though left ventricular dysfunction in takotsubo cardiomyopathy is transient, it can lead to acute complications. Left ventricular thrombus formation is a widely reported complication and has an incidence of around 5-14% in Takotsubo cardiomyopathy patients and can lead to thromboembolic events like stroke. We report a case of takotsubo cardiomyopathy with an apical LV thrombus, complicated by a large cardioembolic stroke. This case constitutes a clinical conundrum, as LV thrombus would warrant prompt initiation of anticoagulation, while the severe ischemic stroke would be a contraindication for immediate anticoagulation.
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Yarrarapu et al. (2023) conducted a case report in Takotsubo cardiomyopathy with apical thrombus and cardioembolic stroke (n=1). IV heparin drip was evaluated. A 77-year-old male with Takotsubo cardiomyopathy developed a massive apical thrombus and subsequent severe cardioembolic stroke, highlighting the clinical dilemma of initiating anticoagulation.
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