PMC6803752_01
EKG on presentation showing sinus rhythm with prolonged PR interval.
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Initial EKG showed no acute changes but prolonged PR interval of 324 milliseconds (Figure 1).
Coronary angiogram showing LAD caudal view.
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Coronary angiogram demonstrated a nonobstructive coronary artery disease (Figures 2 and 3) with a ventriculogram showing apical ballooning and ejection fraction of 40% suggestive of takotsubo cardiomyopathy (Figures 4 and 5).
Coronary angiogram showing a view of the right coronary artery.
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Coronary angiogram demonstrated a nonobstructive coronary artery disease (Figures 2 and 3) with a ventriculogram showing apical ballooning and ejection fraction of 40% suggestive of takotsubo cardiomyopathy (Figures 4 and 5).
Left ventriculogram in systole.
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Coronary angiogram demonstrated a nonobstructive coronary artery disease (Figures 2 and 3) with a ventriculogram showing apical ballooning and ejection fraction of 40% suggestive of takotsubo cardiomyopathy (Figures 4 and 5).
Left ventriculogram in diastole.
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fig5
Coronary angiogram demonstrated a nonobstructive coronary artery disease (Figures 2 and 3) with a ventriculogram showing apical ballooning and ejection fraction of 40% suggestive of takotsubo cardiomyopathy (Figures 4 and 5).
Apical 4 chamber ECHO view (a) on presentation suggestive of takotsubo cardiomyopathy followed by repeat apical 4 chamber view (b) two months later showing recovery of previously noted wall motion abnormalities.
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The patient was admitted to the CCU, and a transthoracic echo was done and consistent with the findings of coronary catheterization: it showed an ejection fraction of 45% with hyperdynamic inferobasal and anterior basal walls with apical ballooning indicative of takotsubo cardiomyopathy (Figure 6). A repeat echocardiogram was done outpatient, two months after hospitalization, and showed improvement: she had an ejection fraction of 55-60% with resolution of the apical ballooning and hyperdynamic wall motion changes, which were initially noted during hospitalization (Figure 6).
EKG showing Mobitz type 1 AV block.
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Her hospitalization was complicated by Mobitz 1 AV block (Figure 7), wide complex escape rhythms, and subsequent complete heart block (Figure 8).
EKG showing third degree complete AV block.
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fig8
Her hospitalization was complicated by Mobitz 1 AV block (Figure 7), wide complex escape rhythms, and subsequent complete heart block (Figure 8).