Case Report: Onset of Takotsubo syndrome during a heart rehabilitation session

Figures

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  Figure 1. Telemetry during exertion in the eighth session of the heart rehabilitation program showing ventricular bigeminy with extrasystole and tachycardia with wide QRS complex episodes reaching 130–140 beats per minute and ST-segment elevation.

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  Figure 2. ECG performed in the Cardiology Department demonstrating sinus tachycardia at 100 bpm, narrow QRS complexes, inferior Q waves, slow R-to-S progression in the precordial leads, and isolated J-point elevation in lead V6.

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  Figure 3. Coronary angiography with no evidence of coronary artery obstruction (A). Ventriculography performed in the left ventricle revealing akinesia and ballooning of the middle and apical segments , indicating severe dysfunction in the end-systolic phase (B). Normal left ventricular contraction during the end-diastolic phase (C).

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  Figure 4. Cardiac magnetic resonance imaging showing a dilated, non-hypertrophic left ventricle with a moderately depressed left ventricular ejection fraction (LVEF 39%) and noticeable hypokinesia in the mid-apical segments during systole (A) and normal contraction in the diastole (B), and T2-STIR sequence showing a marked increase in signal intensity in the mid-apical segments, consistent with diffuse myocardial edema (C). No intracavitary thrombi or pericardial or pleural effusions were observed. Therefore, according to these findings, the patient was diagnosed with TTS.