Transient Midcavity Obstruction from Hyperdynamic Mid–Left Ventricular Segments during Recovery from Classical Takotsubo Syndrome

Figures

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  Figure 1. Serial 12-lead ECG tracings from index TTS presentation (A), readmission 3 weeks later (B), and follow-up 5 weeks after index event (C) demonstrate atrial fibrillation with rapid ventricular response, premature ventricular contractions, and nonspecific ST changes initially, new anterolateral T-wave inversions consistent with the evolving phase of TTS, and resolution of prior anterolateral T-wave inversions.

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  Figure 2. Two-dimensional TTE, apical 4-chamber diastolic (A) and systolic (B) views obtained at initial hospitalization after the administration of an ultrasound-enhancing agent, demonstrates severely reduced LV systolic function with apical and midsegment akinesis and ballooning consistent with classic TTS.

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  Figure 3. Invasive coronary angiography, left-anterior oblique cranial view with selective left coronary artery enhancement (A) and right-anterior oblique cranial view with selective right coronary artery enhancement (B), demonstrates normal origin and course of native coronary arteries without obstructive coronary artery disease.

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  Figure 4. Two-dimensional TTE, apical 4-chamber diastolic (A) and systolic (B) views obtained during readmission 3 weeks after TTS diagnosis, after the administration of an ultrasound-enhancing agent, demonstrates a recovered normal LV systolic function with new systolic cavity obliteration and hyperdynamic motion in the mid-LV wall segments and persistent, but smaller, apical akinesis.

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  Figure 5. Two-dimensional TTE with color-flow Doppler, apical 4-chamber view (A) and continuous-wave Doppler spectral display (B) obtained during readmission 3 weeks after TTS diagnosis, demonstrates flow acceleration in the mid–left ventricle (arrow in A), which correlates with a midcavity gradient of 60 mm Hg (arrow in B).

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  Figure 6. Two-dimensional TTE, apical 4-chamber diastolic (A) and systolic (B) views obtained 5 weeks after TTS diagnosis, after the administration of an ultrasound-enhancing agent, demonstrates normal global LV systolic function with near normalization of the LV apical function and morphology and resolution of the midcavity obliteration.

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  Figure 7. Two-dimensional TTE with color-flow Doppler, apical 4-chamber systolic view (A) and continuous-wave Doppler spectral display (B) obtained 5 weeks after TTS diagnosis, demonstrates flow acceleration in the mid–left ventricle (arrow in A), which correlates with a midcavity gradient of 28 mm Hg (arrow in B).

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  Figure 8. Two-dimensional TTE, apical 4-chamber diastolic (A) and systolic (B) obtained 6 months after TTS diagnosis, demonstrates normal global and regional LV systolic function.