When Broken Hearts Clot: Takotsubo Cardiomyopathy With Left Ventricular Thrombus

Background: Takotsubo Syndrome (TTS) is a transient, stress-induced cardiomyopathy that mimics acute myocardial infarction in the absence of obstructive coronary artery disease. Although often self-limiting, TTS may lead to serious complications, including left ventricular (LV) thrombus formation. Case Summary: A 73-year-old woman with a complex medical history was referred to the emergency department for an abnormal electrocardiogram. She reported transient dyspnea and indigestion but denied chest pain. Laboratory evaluation demonstrated elevated high-sensitivity troponin I and B-type natriuretic peptide. Electrocardiography showed new diffuse T-wave inversions. Coronary angiography revealed non-obstructive coronary artery disease. Transthoracic echocardiography demonstrated apical akinesis with a large LV thrombus and mildly reduced ejection fraction. The patient was treated with systemic anticoagulation and supportive therapy, resulting in complete recovery of ventricular function and thrombus resolution on follow-up imaging at five months. Discussion: LV thrombus is an uncommon but clinically important complication of TTS, occurring in approximately 2–3% of cases, likely related to apical hypokinesis and catecholamine-mediated endothelial injury. In the absence of definitive guidelines, anticoagulation for approximately three months is commonly recommended in patients with LV thrombus or severe systolic dysfunction. Conclusion: LV thrombus can complicate TTS even with only mildly reduced systolic function, underscoring the importance of early imaging and timely anticoagulation