Successful Conservative Treatment of Cardiac Rupture Associated with Takotsubo Syndrome

Abstract

We herein report a 75-year-old woman who was diagnosed with Takotsubo syndrome (TTS) complicated by left ventricular outflow tract obstruction on admission. Treatment with beta-blocker and anticoagulant was started; however, her hemoglobin level decreased gradually, and computed tomography performed one week later revealed hemopericardium. Oozing-type cardiac rupture was suspected; therefore, we discontinued heparin treatment. Finally, she recovered uneventfully without cardiac surgery. It is noteworthy that cardiac rupture may occur with TTS, especially in patients treated with prophylactic anticoagulation therapy for apical thrombus. Furthermore, conservative, careful observation is an alternative approach in patients with oozingtype cardiac rupture associated with TTS.

Takotsubo Cardiomyopathy: Current Treatment

“…The bulk of the literature supports the view that heparin should be initiated in the presence of thrombus, followed by warfarin until at follow-up the thrombus has resolved, with some adding aspirin to this antithrombotic regimen [ 55 , 56 , 57 , 58 ]. The issue of anticoagulation should be considered broadly, encompassing its consideration for patients with TTS and severe LVWMAs and their duration without presence of intraventricular thrombus, presence of thrombus, and concern about the role of anticoagulation in causing cardiac rupture, a rare complication of TTS [ 20 , 59 ]. Important issues are the vigilance for the emergence of thrombus, early implementation of anticoagulation, and its maintenance for 3 to 4 or 6 months, as the resolution of the thrombus and LV dysfunction takes place.…”