PMC9719912_01
An electrocardiogram demonstrating sinus tachycardia, low limb lead voltage, and ST-segment elevation in leads V2-V5.
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Electrocardiography (ECG) revealed sinus tachycardia, low limb lead voltage, and ST-segment elevation in leads V2-V5 of 0.1-0.3 mV (Figure 1). Follow-up ECG revealed a gradual decrease in the ST-segment elevation in leads V2-V5 with T-wave inversion appearing on the 8th day of admission (Supplementary Figure 1).
Apical four-chamber view echocardiogram reveals apical dyskinesis and basal to midventricular hyperkinesis (A,B), as well as apex systolic function improvement (C,D). (A,C) Diastole. (B,D) Systole.
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Impaired left ventricular systolic function with an ejection fraction of 40% accompanied by hypokinetic apical movement, paradoxical movement of the myocardium from the papillary muscle to the apex, mild mitral regurgitation, and moderate-to-severe tricuspid regurgitation were detected using transthoracic echocardiography (UCG) (Figures 2A,B). Chest CT on day 14 showed minimal percolation from both lungs and bilateral pleural effusion (Supplementary Figures 2A,B). CT on day 21 revealed significantly reduced pleural fluid and pulmonary exudate (Supplementary Figures 2C,D). CMR examination performed 3 weeks after admission indicated that the heart apex was bulging toward the diaphragm with hypoactive contraction in the local left ventricle. UCG on day 24 revealed improvement in left ventricular systolic function with an ejection fraction of 54% (Figures 2C,D).
Coronary angiography and intravascular ultrasound show 30% stenosis of the left anterior descending coronary artery with no plaque rupture or dissecting hematoma. The a, b, and c arrows on the left correspond to the ultrasound positions labeled a-c on the right (A). Left ventricular angiography shows a takotsubo contractile pattern with apical dyskinesis and basal hyperkinesis (B,C). (B) Systole. (C) Diastole.
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The next day, percutaneous coronary angiography revealed 30% stenosis of the middle of the left anterior descending coronary artery (Figure 3A). Left anterior descending coronary artery intravascular ultrasonography showed partial intimal calcification of the coronary plaque but no plaque rupture or dissecting hematoma (Figure 3A). Left ventricular angiography revealed a takotsubo contractile pattern consisting of apical dyskinesis and basal hyperkinesis (Figures 3B,C).
Long-axis cardiac magnetic resonance shows the heart apex bulging toward the diaphragm (A). Late gadolinium enhancement reveals a weakly enhanced interventricular septum (B).
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Late gadolinium enhancement showed a weakly enhanced interventricular septum (Figure 4).