Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy in a Patient with Preexisting Hypertrophic Obstructive Cardiomyopathy

Figures

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  Figure 1. The initial electrocardiogram showing sinus tachycardia with premature atrial contractions and intermittent ventricular pacing with ST-T wave abnormalities in anterolateral leads.

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  Figure 2. The initial chest x-ray demonstrates cardiomegaly with interstitial and alveolar opacities consistent with pulmonary edema and ICD leads positioned in right atrial appendage and right ventricular apex.

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  Figure 3. CW Doppler imaging in the apical four-chamber view demonstrating late peaking dynamic LVOTO gradient of over 90 mm Hg (peak velocity 5 m/sec).

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  Figure 4. CW Doppler in the apical long-axis view showing a gradient of 99.28 mm Hg.

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  Figure 5. Apical four-chamber view showing hypokinesis of the apical interventricular septum, apex, and apical lateral walls (red arrows).

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  Figure 6. Apical long-axis (LAX) view showing flow acceleration and the posteriorly directed mitral regurgitation jet.

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  Figure 7. Biplane Simpson's method of disks performed in the apical four-chamber (4CH) view showing improved ejection fraction (EF) of 74%.

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  Figure 8. The follow-up echocardiogram with CW Doppler in the apical long-axis (LAX) view showing a resolved gradient of 22.33 mm Hg.