Takotsubo Cardiomyopathy and Acute Ischemic Stroke

Alexandre Amaral-Silva, Miguel Lourenço, Renato Fernandes, Duarte Cacela, Joao Alcantara

Abstract


Takotsubo cardiomyopathy and acute ischemic stroke. The Takotsubo cardiomyopathy is characterized by transient left ventricle dysfunction, with apical ballooning in the absence of significant coronary stenosis, and may clinically mimic an acute myocardial infarction. The association between Takotsubo cardiomyopathy and several acute neurological conditions has been increasingly described. The authors present the case report of an acute stroke patient submitted to intravenous thrombolysis, whose EKG on admittance showed supra-ST deviation in DI, AVL and V2-V6 leads, with concomitant elevation of myocardial necrosis biomarkers. After intravenous thrombolysis, a cardiac catheterism was performed that showed apical ballooning and acinesia of the left ventricle with decreased ventricular function, with no significant coronaropathy. The cerebral MRI performed on the seventh day showed multiple acute infarctions in different vascular territories of the anterior and posterior circulations bilaterally. Transthoracic echocardiogram performed on the same day revealed normal ventricular function and myocardial kinetics supporting the diagnosis of Takotsubo cardiomyopathy. The patient was discharged on day 10, on hypocoagulation therapy. Takotsubo cardiomyopathy is a spontaneously reversible condition, mostly requiring supportive therapeutic measures. The acute left ventricle dysfunction characteristic of this syndrome is a potential mechanism for cardiac embolism. Acute ischemic stroke is a relatively rare but severe complication. According to this, hypocoagulant therapy must be considered especially until the ventricular function is fully recovered.




J Med Cases. 2012;3(6):347-351
doi: https://doi.org/10.4021/jmc776w

Keywords


Takotsubo cardiomyopathy; Apical ballooning; Left ventricle dysfunction; Stroke; Hypocoagulation

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