Clinical Case: Takotsubo Cardiomyopathy

A 45-year-old lady presents to the emergency department after experiencing chest pain at her mother's funeral. An ECG performed reveals ST segment elevation in the V1-V4 leads. She undergoes emergency cardiac catheterization, but coronary arteries are normal.

A bedside echocardiogram performed after the procedure reveals the following images:

This case is an example of Takotsubo Cardiomyopathy, or "broken heart syndrome". It is an acute presentation of left ventricular systolic dysfunction that is very similar to myocardial infarction. Howeverm the dysfunction in Takotsubo Cardiomyopathy is not confined to one artery territory, nor is there any occlusive coronary artery disease found on cardiac catherterisation.

Generally, the systolic dysfunction affects the mid-apical portions of the left ventricle, causing the classic "apical ballooning pattern" as seen in the video above. The term "Takotsubo Cardiomyopathy" comes from this pattern seen on echography, which is similar to the Japanese octopus trap of the same name pictured below.

The first ultrasound image demonstrates the apical ballooning of the left ventricle. The second view demonstrates the difference in contractility of the apical and mid regions compared to the basal regions of the heart. As you can see, there is better contraction of the left ventricle in later images, which corresponds with the more basal regions of the heart.

Takotsubo Cardiomyopathy is a great example of how bedside ultrasound can be used to assist with the diagnosis of certain clinical entities.