A 64-Year-Old Woman With Extremity Swelling and Cough

Francisco Aguilar, MD; Carla Arellano Pizano, MD


July 17, 2018


Two-dimensional echocardiogram revealed left ventricular ejection fraction of 30% to 35%; and severe hypokinesis of the mid-to-distal septum, anterior wall, inferior wall, and apex, with wall motion preserved in the basal segments compatible with Takotsubo cardiomyopathy. No left ventricular outflow obstruction was present, and no intracavitary thrombus was observed. Left ventriculography during systole confirmed the apical ballooning pattern.

Takotsubo cardiomyopathy is a transient myocardial dysfunction characterized by left ventricular apical ballooning, with or without dyskinesis/akinesis of the midsegments in the absence of significant coronary artery disease (> 50% stenosis of the left main stem, > 70% stenosis in a major coronary vessel, or 30% to 70% stenosis, with fractional flow reserve ≤ 0.8). Sato et al were the first to describe this syndrome in 1990 and named it Takotsubo, which means "octopus trap" in Japanese.[1] They chose this name because of the similarities of the morphology of the left ventricle with an octopus trap.

This disorder more commonly affects postmenopausal women, and the symptoms are often preceded by a triggering factor (ie, emotional or physical stress). Common emotional stressors described in the literature include the death of a relative or friend, interpersonal conflict, a severe medical diagnosis, and the sudden loss of money or valuables. Physical stressors include invasive procedures, exacerbation of systemic diseases, and acute infections. However, the absence of a stressor does not rule out this condition; as many as one third of patients report no evident trigger.[2]


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