Unusual case of left ventricular ballooning involving the inferior wall: a case report

Rognoni, Andrea; Bertolazzi, Marzia; Macciò, Sergio; Reale, Danilo; Proietti, Riccardo; Rognoni, G

doi:10.1186/1757-1626-2-140

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…In our case, echocardiographic images showed akinesis of the basal anterior wall, and of the entire interventricular septum associated with hypokinesis of the basal segments of the inferior wall (Table 1) [14,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Our case combined the anatomic abnormalities previously classified as type two, three and four.…”

Section: Discussionsupporting

confidence: 66%

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

et al. 2010

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A 69-yearold Caucasian woman was admitted to our emergency department (ED) for an acute and initial episode of substernal chest pain radiating to the left arm, which had lasted about 1 h, associated with dyspnea and diaphoresis. She had a past medical history of depression and first stage primary biliary cirrhosis. She was taking chronic low-dose sotalol therapy (80 mg PO bid) for a prior episode of supraventricular tachycardia. She had an otherwise normal heart, and was without cardiovascular risk factors.At admission, she denied any recent emotional or stressful event. The first EKG recorded 10 min after the ED admission showed mild ST-segment depression in the precordial leads V5 and V6 ( Fig. 1), without significant changes in the inferior, posterior and right precordial leads.The first blood sample analysis exhibited normal values of Troponin-I (cTn-I: 0.10 lg/L, normal range: 0-0.15 lg/L) and CK-MB (1.1 ng/ml, normal range: 0.5-3.6 ng/ml).The patient, fully asymptomatic, was admitted to our intensive observation unit.Based on our protocol, a second blood chemistry control was performed 6 h after the initial results. An elevated cTn-I value of 3.31 lg/L with normal CK-MB value (1.0 ng/ml) was observed. The EKG registered at the same time as the laboratory blood tests showed T-wave inversion in the precordial leads from V1 to V4 (Fig. 2), not present in the first tracing,and a small QT dispersion with a QT interval a bit longer than previous EKG. Trans-thoracic echocardiography showed normal left ventricular internal dimensions; the segmental wall motion analysis revealed akinesis of the basal anterior wall and the entire interventricular septum associated with hypokinesis of the inferior wall basal segments. Posterolateral basal segments and all mid-ventricular and apical segments appeared hyperkinetic. Preliminary diagnosisDr. Zanobetti, Dr. Conti, Dr. Pini: Based on the initial presentation, EKG abnormalities and a positive marker of myocardial necrosis, an acute coronary syndrome, myocarditis, or an atypical presentation of Tako-Tsubo syndrome were considered.None of the serial EKGs exhibited abnormalities characteristic of an acute coronary syndrome, and there was a mismatch between the limited extension of EKG abnormalities and the diffuse wall motion abnormalities in the echocardiographic examination. This mismatch can support the diagnosis of myocarditid, especially in the presence of limited abnormalities of myocardial specific enzymes. However, all indices of inflammation (C-Reactive Protein, leucocytes, erythrocyte sedimentation rate)

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Section: Discussionsupporting

confidence: 66%

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

et al. 2010

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“…The basal type appears like a counterpart to the apical type, with basal stunning and midventricular and apical hypercontraction [105,106]. The focal type occurs with focal stunning, most frequently in anterolateral or posterolateral segments [107,108], and is often found with the most preserved LVEF and low-est complication rate of all types [104]. According to data from the InterTAK Registry, the TS type is not associated with clinical outcomes after adjusting for confounders [109].…”

Section: Types Of Tsmentioning

confidence: 99%

Takotsubo syndrome: between evidence, myths, and misunderstandings

Napp

Bauersachs

2020

Herz

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Takotsubo syndrome (TS) is an acute cardiac condition characterized by transient wall motion abnormalities mostly of the left ventricle. First described in 1990, TS has gained substantial attention during the past 15 years. However, the disease is still underdiagnosed. Prospective studies on TS are largely lacking, and the condition remains incompletely understood. In addition, significant misconceptions and misunderstandings are evident, contributing to potentially severe underestimation. Here, we review important aspects of TS with a focus on pitfalls, misinterpretations, and knowledge gaps considered important during diagnosis and management of the disease.

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