PMC4971286_01
(a) EKG on admission with normal QTc of 446 ms. (b) Close-up of lead V2.
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Since admission, the patient had progressive T wave changes (Figures 1 and 2).
(a) After 12 hours of admission, progressive T wave inversion; the QTc is being prolonged of 491 ms. (b) Close-up of lead II.
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Since admission, the patient had progressive T wave changes (Figures 1 and 2).
After 22 hours of admission, telemetry strip showing TdP.
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After the patient was admitted to the coronary care unit, the patient was found to be in torsades de pointes (TdP) pulseless polymorphic ventricular tachycardia (Figure 3).
(a) After TdP, progressive T wave inversion and QTc prolongation of 691 ms. (b) Close-up of lead II.
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T wave inversions worsened with evidence of prolonged QTc (Figure 4). The patient was intubated to maintain and protect airways.
Echocardiographic evidence of classic takotsubo cardiomyopathy, the apical type. (a) represents diastole and (b) represents systole.
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The patient was scheduled for a transthoracic echocardiogram (TTE) and a cardiac catheterization the following day. The TTE revealed a reduced left ventricular ejection fraction (25%-30%) with apical wall motion abnormalities consistent with a great likelihood of classic takotsubo cardiomyopathy, the apical type (Figure 5).
Angiogram reveals normal coronary arteries.
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A coronary angiogram was performed a few days later and did not show any significant coronary artery disease (Figure 6).
Echocardiographic evidence of normalization of left ventricular ejection fraction. (a) represents diastole and (b) represents systole.
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Patient had repeated echocardiogram three months later and left ventricular ejection fraction improved to >55% without any wall motion abnormality (Figure 7).