PMC5671690_01
ECG during first episode of Takotsubo stress cardiomyopathy with ST elevation V1-V6, Q waves in V1-V3.
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Her initial ECG showed ST elevations in the anteroseptal leads (V1-V4) (Figure 1) and troponin elevation concerning for ST elevation myocardial infarction (STEMI) and she had emergent cardiac catheterization. Left ventriculogram suggested severe LV dysfunction and transthoracic echocardiogram (TTE) confirmed mid ventricular variant Takotsubo stress cardiomyopathy with reduced ejection fraction (EF) of 25% (Figure 2 and Table 1).
Left ventriculogram in RAO projection in diastole (a) demonstrates normal cavity contour and in systole (b) preserved basal and apical contractility with akinesia of the mid ventricle consistent with Takotsubo stress cardiomyopathy.
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Left ventriculogram suggested severe LV dysfunction and transthoracic echocardiogram (TTE) confirmed mid ventricular variant Takotsubo stress cardiomyopathy with reduced ejection fraction (EF) of 25% (Figure 2 and Table 1).
ECG during second SC episode with deep symmetrical T inversions in leads V1-V6.
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One year later, she had a similar episode of ophthalmoparesis, generalized weakness with acute chest pain, troponemia with deep T wave inversions in V1-V6 leads on ECG (Figure 3) with TTE showing mid and apical akinesia, and EF 30% consistent with classical apical ballooning type of Takotsubo stress cardiomyopathy (Table 1).
ECG 3 days later showing nonspecific ST-T wave changes only.
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We diagnosed her with recurrent Takotsubo stress-induced cardiomyopathy secondary to myasthenia crisis and treated her with 5 cycles of PLEX with complete resolution of the ST elevations (Figure 4) and troponemia and she was discharged to rehabilitation facility.