The Korean journal of internal medicine

  • 제26권4호
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  • Pages.455-459
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  • 2011
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Takotsubo Cardiomyopathy: A Case of Persistent Apical Ballooning Complicated by an Apical Mural Thrombus

  • Lee, Pil-Hyung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Jae-Kwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, In-Keun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sun, Byung-Joo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Seung-Geun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yim, Ji-Hye (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Hyung-Oh (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2011.12.01
⟨ 이전 논문 다음 논문 ⟩

초록

Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.

키워드

참고문헌

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피인용 문헌

  1. Irreversible apical ballooning may also occur vol.74, pp.7, 2011, https://doi.org/10.12968/hmed.2013.74.7.415
  2. A Case of Persistent Apical Ballooning Complicated by Apical Thrombus in Takotsubo Cardiomyopathy of Systemic Lupus Erythematosus Patient vol.21, pp.3, 2011, https://doi.org/10.4250/jcu.2013.21.3.137
  3. Clinical Management of Takotsubo Cardiomyopathy vol.78, pp.7, 2014, https://doi.org/10.1253/circj.cj-14-0382
  4. Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report vol.77, pp.1, 2014, https://doi.org/10.4046/trd.2014.77.1.24
  5. Transient midventricular ballooning syndrome with thrombus post pericardiocentesis in a patient with malignant breast cancer vol.45, pp.1, 2011, https://doi.org/10.1002/jcu.22369
  6. Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review vol.17, pp.None, 2011, https://doi.org/10.1186/s12872-017-0616-0
  7. Dobutamine/norepinephrine : Persistent apical ballooning: case report vol.1758, pp.1, 2011, https://doi.org/10.1007/s40278-019-63700-6