Takotsubo Cardiomyopathy–Induced Conduction System Quiescence With Concomitant Fascicular Ventricular Tachycardia and Complete Heart Block

Figures

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  Figure 1. Initial 12-Lead Electrocardiogram on Presentation (Heart Rate: 140 beats/min, QTc 555, Left-Axis Deviation, Supraventricular Tachycardia With Aberrancy vs Ventricular Tachycardia)

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  Figure 2. Repeat 12-Lead Electrocardiogram (Heart Rate: 32 beats/min, Left Axis Deviation, QTc 420, CHB With Junctional Escape; Atrial Rate: 80 beats/min, Ventricular Rate: 30 beats/min) CHB = complete heart block.

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  Figure 3. Limited Transthoracic Echocardiography Showing an Ejection Fraction of 15%, Akinesis of the Mid and Apical Segments, and Hypercontractility of the Cardiac Base

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  Figure 4. Right Heart Catheterization Showing Low Cardiac Output, Borderline Cardiac Index, and Elevated Filling Pressures Consistent with WHO Group II Mild Pulmonary Hypertension Secondary to Acute Left Myocardial Dysfunction in TCM Ao sat = aorta saturation; CI = cardiac index; CO = cardiac output; MAP = mean arterial pressure; PA = pulmonary artery; Pa sat = pulmonary artery saturation; PCWP = pulmonary capillary wedge pressure; RA = right atrium; RFV = right femoral vein; RHC = right heart catheterization; RV = right ventricle; SVR = systemic vascular resistance; TCM = Takotsubo cardiomyopathy TPG = transpulmonary pressure gradient; WHO = World Health Organization.

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  Figure 5. Findings on Left Heart Catheterization Left heart catheterization with an LVEDP of 16 mm Hg and 40% stenosis of the mid-LAD with myocardial bridging, nonobstructive CAD in the LCx (A) and RCA (B), and hypokinesis of the anterolateral, apical, and diaphragmatic walls with an ejection fraction of 25% and anterior and apical hypokinesis with preserved basal contractility (C), suggestive of a stress-induced cardiomyopathy. CAD = coronary artery disease; LAD = left anterior descending artery; LCx = left circumflex artery; LVEDP = left ventricular end-diastolic pressure; RCA = right coronary artery.