A curious Takotsubo cardiomyopathy after COVID-19

Figures

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  Fig. 1. 12-lead electrocardiograms taken on the first and second days. ST elevation of Ⅰ, V1-V3 and ST depression of II, III, and aVf (A) and giant negative T waves observed in ⅠaVL V1-V5 (B).

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  Fig. 2. Thoracoabdominal plain CT and coronary angiography on the first day. CT revealed patchy ground-glass opacities and thickening of the interlobular septa in both lungs, as well as a small amount of ascites and edema in the fatty tissue of the mesenteric membrane, suggesting COVID-19-related pneumonia and enteritis (A, B; black arrows indicate pneumonia, white circles pneumonia enteritis). No significant stenosis was observed in the left and right coronary arteries (C, D).

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  Fig. 3. Simultaneous binuclear myocardial scintigraphy of thallium and BMIPP images on the 11th day and 4 months later. A mismatch between thallium and BMIPP was observed in the anterior wall region, but not in the apical region (A). The blood flow/metabolic mismatch observed during the acute phase disappeared during the chronic phase (B). Video Legends. Video 1: Echocardiograms on the first day and 1 month later. The 3-chamber view showed thinning of the wall from the mid of the anterior septum to the apex of the heart, a protruding aneurysm-like left ventricular wall, and severe wall hypokinesis (A). The ventricular aneurysm-like image of reduced wall motion had disappeared (B). Video 2: Left ventricular contrast image on the first day. No contraction was observed in segment 1 and segment 2 instead of segment 3, and hypercontraction was observed in other segments. Local wall motion abnormality resembling a giant ventricular aneurysm was observed in the left ventricle.