Critical Takotsubo Cardiomyopathy Complicated by Ventricular Septal Perforation

Tadao Aikawa; Mamoru Sakakibara; Masayuki Takahashi; Kyoko Asakawa; Yutaka Dannoura; Takao Makino; Tetsuro Koya; Hiroyuki Tsutsui

doi:10.2169/internalmedicine.54.3475

CASE REPORTS

Critical Takotsubo Cardiomyopathy Complicated by Ventricular Septal Perforation

Tadao Aikawa, Mamoru Sakakibara, Masayuki Takahashi, Kyoko Asakawa, Yutaka Dannoura, Takao Makino, Tetsuro Koya, Hiroyuki Tsutsui

Author information

Tadao Aikawa
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan
Mamoru Sakakibara
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan
Masayuki Takahashi
Department of Cardiovascular Medicine, Sapporo City General Hospital, Japan
Kyoko Asakawa
Department of Cardiovascular Medicine, Sapporo City General Hospital, Japan
Yutaka Dannoura
Department of Cardiovascular Medicine, Sapporo City General Hospital, Japan
Takao Makino
Department of Cardiovascular Medicine, Sapporo City General Hospital, Japan
Tetsuro Koya
Department of Cardiovascular Medicine, Sapporo City General Hospital, Japan
Hiroyuki Tsutsui
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan

Keywords: Takotsubo cardiomyopathy, apical ballooning, ventricular septal perforation, prolonged QT interval, ventricular fibrillation

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 1 Pages 37-41

DOI https://doi.org/10.2169/internalmedicine.54.3475

Details

Abstract

An 81-year-old woman was admitted with chest pain. An electrocardiogram demonstrated ST segment elevation in leads II, III and aVF, and echocardiography revealed left ventricular apical asynergy with a left-to-right ventricular shunt. Meanwhile, emergent coronary angiography showed no significant coronary artery stenosis, whereas left ventriculography indicated apical ballooning and a left-to-right ventricular shunt. We therefore diagnosed the patient with Takotsubo cardiomyopathy complicated by ventricular septal perforation and cardiogenic shock. An electrocardiogram disclosed a prolonged QT interval over time, and the patient became hemodynamically stable under treatment with inotropes; however, she suddenly developed fatal ventricular fibrillation three days after hospitalization. Takotsubo cardiomyopathy complicated by ventricular septal perforation is a critical condition that requires careful monitoring.

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