Successful Conservative Treatment of Cardiac Rupture Associated with Takotsubo Syndrome

Figures

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  Figure 1.. The time-course of 12-lead electrocardiography; The electrocardiogram on admission showed abnormal Q wave in leads V3-6, slight ST-segment elevation in leads V3-5 and inverted T waves in leads V2-5. On day 7, persistent ST-segments elevation was observed in leads V3-6. On day 14, a deeply inverted T-wave was observed in leads V2-6.

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  Figure 2.. Echocardiographic images following admission. The echocardiogram during diastole (A) and systole (B) showed apical akinesis, with no pericardial effusion. LV outflow tract obstruction (LVOTO) accompanied by moderate mitral regurgitation was observed (C). Doppler waveforms indicated that the peak velocity of the left ventricular outflow obstruction was 3.1 m/s (D).

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  Figure 3.. Angiographic images following admission; A coronary angiogram demonstrated no obstructive coronary artery disease in the right (A) or left (B) coronary systems. A left ventriculogram, during diastole (C) and systole (D), indicated apical ballooning and basal hyperkinesis consistent with Takotsubo syndrome.

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  Figure 4.. Computed tomography (CT) performed on the seventh day following admission showed a moderate amount of pericardial effusion with high CT attenuation values suggestive of hemopericardium (A). Echocardiography also showed pericardial effusion, with improved left ventricular segmental asynergy during diastole (B) and systole (C). CT performed two weeks (D) and six weeks (E) later showed that the pericardial effusion had decreased gradually. Cardiac magnetic resonance imaging (F) performed six months later showed no wall motion abnormalities, pericardial effusion, or late gadolinium enhancement, which is consistent with the progress of Takotsubo syndrome.