Left ventricular apical aneurysm caused by takotsubo cardiomyopathy

Abstract

A 78-year-old woman with hypertension was admitted to our hospital with palpitation and chest discomfort. She had been nervous since she learned about a severe earthquake on the news. An electrocardiogram showed ST-segment elevation in leads I, aVL, and V2-6. Emergency coronary angiography demonstrated no significant coronary stenosis and left ventriculography revealed marked akinesis of apical left ventricle with hyperkinesis of the basal segments, indicating typical takotsubo cardiomyopathy. On day 24, an electrocardiogram showed diffuse T-wave inversion, but ST-segment elevation remained in V3-6. Cardiac magnetic resonance imaging revealed left ventricular apical aneurysm and epicardial late gadolinium enhancement in the apex, indicating takotsubo-inflicted myocardial injury. Although many previous reports show takotsubo cardiomyopathy is a reversible left ventricular systolic dysfunction with less significant complications, it should be reconsidered as benign disease with long-term complications.

Learning objective: Although many previous reports show takotsubo cardiomyopathy (TC) is a reversible left ventricular (LV) systolic dysfunction with less significant complications, our patient is a rare case of TC which led to LV apical aneurysm. It was believed that lack of late gadolinium enhancement (LGE) was necessary to diagnose TC, however we detected epicardial LGE in the LV apical wall and this finding might indicate nonreversible change in this case.

Keywords: Cardiac magnetic resonance imaging; Late gadolinium enhancement; Left ventricular apical aneurysm; Takotsubo cardiomyopathy.