Key result
Takotsubo syndrome case shows rapid wandering of systolic dysfunction with complete recovery at one week.
Case Report (n=1)
Takotsubo syndrome can present with rapidly evolving or 'wandering' patterns of left ventricular ballooning, challenging traditional static classifications.
May prompt serial imaging in Takotsubo; leaves open prevalence and outcomes of dynamic ballooning patterns.
We report the case of a 53-year-old woman admitted for typical chest pain and a diagnosis of Takotsubo syndrome (TTS). Initial echocardiographic presentation was characterized by apical and mid-ventricular akinesis and basal hyper-kinesis. Unexpectedly, later after admission, echocardiography showed recovered apical akinesis with an apparent 'migration' of systolic dysfunction to mid-ventricular segment and hyper-kinesis of apical and basal segments. One week after admission, left ventricular contractility completely recovered and cardiac magnetic resonance imaging did not show signs of subendocardial late-enhancement and myocardial edema. Cases of TTS may therefore occasionally rapidly 'wander' within left ventricular segments, raising doubts over the so far used classification of left ventricular patterns of ballooning in subjects with TTS (typical/atypical). Apparently, different patterns can rapidly evolve into each other. The absence of late-enhancement at cardiac magnetic resonance imaging could hypothetically identify rapidly 'wandering' cases.
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Casavecchia et al. (2017) conducted a case report in Takotsubo syndrome (n=1). A case of Takotsubo syndrome demonstrated rapid 'wandering' of systolic dysfunction from apical to mid-ventricular segments, with complete recovery and no late-enhancement on MRI at one week.
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