Successful Early Diagnosis of Takotsubo Cardiomyopathy Induced by Status Epilepticus and Pneumonia Following the Exacerbation of Gastroesophageal Reflux Disease: A Case Report

Figures

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  Figure 1. Gastrointestinal series and CT findings. (A) Upper gastrointestinal contrast imaging via a gastrostomy tube two years before this attack demonstrated the simultaneous appearance of the duodenum (black arrow) and esophagus (white arrow) due to a relapse of hiatal hernia (blue dotted circle), including prolapse of esophagofundal wrapping as a filling defect (red dotted circle). (B) CT scan at the onset of this attack indicated a hiatal hernia (yellow arrow). CT: computed tomography

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  Figure 2. A 12-lead ECG findings at before onset, onset, and exacerbation of GERD. (A) ECG before the onset of GERD. (B) ECG at the onset of GERD demonstrated low QRS voltage. (C) ECG during the exacerbation of GERD demonstrated an inverted T wave at the precordial leads. ECG: electrocardiogram; GERD: gastroesophageal reflux disease

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  Figure 3. Chest X-ray and CT findings. (A) Chest X-ray showed cardiomegaly, left pulmonary infiltration, and scoliosis at the onset of illness. (B)-(C) CT demonstrated infiltration in both the left upper and lower pulmonary fields consistent with aspiration pneumonia at the onset of illness. CT: computed tomography

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  Figure 4. A 12-lead ECG findings at the onset of TTC and recovery period. ECG at the onset of illness showed normal sinus rhythm with ST-segment elevations in leads V4-V6 and negative T waves in leads I and II, with a positive T wave in aVR. TTC: Takotsubo cardiomyopathy; ECG: electrocardiogram; aVR: augmented Vector Right; aVL: augmented Vector Left; aVF: augmented Vector Foot

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  Figure 5. TTE findings at the onset of TTC and recovery period. Apical two-chamber view of TTE at the onset of TTC during diastole (A) and systole (B) showed left ventricular apical akinesia (red arrows) and preserved basal contraction (yellow arrows). TTE at the recovery period of TTC during diastole (C) and systole (D) demonstrated improved apical contraction. TTE: transthoracic echocardiogram; TTC: Takotsubo cardiomyopathy

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  Figure 6. Doppler imaging in TTE findings. Continuous wave Doppler imaging in apical two-chamber view of TTE on day 14 showed a peaking dynamic pressure gradient of 43.3 mmHg in the left ventricular outflow tract. TTE: transthoracic echocardiogram