Dynamic left ventricular outflow tract gradient resulting from Takotsubo cardiomyopathy ameliorated by intra-aortic balloon pump counterpulsation: a case report

Figure 1. Twelve-lead electrocardiogram showing diffuse ST-segment depression, T-wave inversion, and QTc prolongation.

Figure 2. Haemodynamic waveform during catheter pullback across aortic valve showing significant left ventricle to aorta gradient of 60 mmHg with focal gradient of 35–40 mmHg within the sub-aortic left ventricular outflow tract.

Figure 3. Transthoracic echocardiography during dobutamine infusion; (A) apical four-chamber view during left ventricular diastole; (B) apical four-chamber view during left ventricular systole showing severe apical ballooning (red arrows) with hyper contractile basal segments; (C) colour-flow Doppler showing significant left ventricular outflow tract turbulence; (D) continuous wave Doppler in the left ventricular outflow tract showing peak pressure gradient of 40 mmHg.

Figure 4. Intra-aortic balloon pump placement; (A) intra-aortic balloon pump positioning in the proximal descending aorta just distal to the left subclavian artery; (B) inflated intra-aortic balloon pump counterpulsation with electrocardiogram-triggering.

Figure 5. Repeat transthoracic echocardiography on Day 6 of admission; complete left ventricular systolic function recovery shown in diastole (A) and systole (B); left ventricular outflow tract gradient has dropped to 7 mmHg on continuous wave Doppler (inset left); 12-lead electrocardiogram at 6-week follow-up showing recovered T-wave changes and QTc of 470 ms (inset right).