PMC8363476_01
12-Lead ECG (A) at admission showing incomplete right branch block, left anterior-superior divisional block, left axis deviation of the QRS, 2:1 AV block, corrected QT interval prolongation (689ms) and inverted T waves; (B) at discharge showing resolution of T wave inversions and shortening of the QT interval after pacemaker implantation.
IMCRJ-14-523-g0001.jpg
PMC8363476_01_IMCRJ-14-523-g0001.jpg
f0001
The electrocardiogram (ECG) on admission (Figure 1A) showed second-degree AV block 2:1, right branch block, left anterior fascicular block, biphasic T wave in DII, DIII, aVF, V1, and V2 and inverted, deep, and asymmetric in DI, aVL, V3, V4, V5, and V6, with QRS duration of 142ms and corrected QT interval of 689ms. ECG at hospital discharge showed complete resolution of T wave inversions and shortening of the QT interval (Figure 1B).
Transthoracic echocardiographic 4-chamber view of the left ventricle in diastole (A) and in systole (B) shows basal hypercontractility (green arrow) and midapical ballooning (yellow arrow).
IMCRJ-14-523-g0002.jpg
PMC8363476_01_IMCRJ-14-523-g0002.jpg
f0002
Cardiac magnetic resonance 4-chamber view of the left ventricle in diastole (A) and in systole (B) showing hypercontractility (green arrow) and typical apical ballooning (yellow arrow) in takotsubo syndrome.
IMCRJ-14-523-g0003.jpg
PMC8363476_01_IMCRJ-14-523-g0003.jpg
f0003
TCM presentation. To expand on the investigation, coronary angiotomography did not show coronary lesions, with a calcium score of zero, and cardiac magnetic resonance (CMR) imaging confirmed the echocardiographic findings and did not show late enhancement (Figure 3).