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Prolonged QT.
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ECG and rhythm strips upon hospitalization (Fig. 1) showed marked repolarization abnormalities with symmetrical deeply inverted T-wave in anterolateral leads, prolonged QT interval (corrected QT interval, 554 milliseconds) and sinus bradycardia (51 beats/min).
Torsade de pointes.
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Telemetry on the coronary care unit showed several episodes of TdP which on five occasions rapidly degenerated to ventricular fibrillation (VF; Fig. 2).
Left ventricular apical ballooning.
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Left ventricular apical thrombus.
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Four days later, while in hospital, repeat echocardiography revealed mild improvement of LV contractility with a rise in EF to 40%; however, there was a moderately sized LV apical thrombus (Fig. 4), hence anticoagulation was commenced.
Left ventricular apical clot resolved.
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This soon resolved on repeat echocardiography 1 week later with marked improvement of LV contractility and once again normalization of LV function with an EF of 55% with resolution of the apical thrombus (Fig. 5).