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Apical ballooning syndrome (takotsubo cardiomyopathy) after permanent dual-chamber pacemaker implantation.

Gardini A, Fracassi F, Boldi E, Albiero R - Case Rep Cardiol (2012)

Bottom Line: Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function.No coronary lesions were found at angiography.The clinical and echocardiographic picture normalized at discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, S. Rocco Hospital, Ome, 25050 Brescia, Italy.

ABSTRACT
Apical ballooning syndrome, also called takotsubo cardiomyopathy, has been recently reported. It may mimic acute myocardial infarction and is typically observed in postmenopausal women after stressful events. A 75-year-old female after permanent dual chamber pacemaker implant complained of chest pain with repolarization alterations suggesting acute myocardial ischemia. Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function. The patient was treated with antithrombotic agents and intravenous nitrates. No coronary lesions were found at angiography. At ventriculography, a typical takotsubo-like shape of the left ventricle was observed. The clinical and echocardiographic picture normalized at discharge.

No MeSH data available.


Related in: MedlinePlus

Ventriculography showing typical takotsubo-like shape of LV.
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fig2: Ventriculography showing typical takotsubo-like shape of LV.

Mentions: A 75-year-old woman with history of hypertension and no previous cardiac symptoms was admitted for syncope and paroxysmal third-degree atrioventricular (AV) block. Preoperative evaluation revealed normal haematological tests, chest X-ray, and echocardiography. The EGC presented first-degree AV block, right bundle branch block, and left anterior fascicular block. A dual-chamber pacemaker (PM) with ventricular lead in the right ventricle (RV) apex was then implanted without procedural complications. On the night following the implant, the patient complained of repeated self-limited episodes of interscapular pain with mild dyspnoea. The day after the ECG showed sinus rhythm triggering PM ventricular stimulation with ST segment elevation in inferior and anterior leads. PM inhibition showed the preexisting intraventricular conduction disturbance with inferior and anterior ST segment elevation (Figure 1). Chest X-ray excluded pneumothorax. At echocardiogram, akinesia of the apical portions of the LV with reduced LV systolic function was observed. Cardiac biomarkers were slightly increased. The patient was treated with intravenous nitrates and antithrombotic agents due to suspicion of AMI. For the persistence of symptoms and ECG alterations, coronary angiography was performed with no evidence of significant coronary lesion or spasm. The ventriculography revealed ballooning of apical region with typical so-called takotsubo shape (Figure 2). In the following days, reduction in ST segment elevation and transient negative T wave were observed at ECG. At predischarge echocardiography, LV systolic function improved, and wall motion abnormalities disappeared. The patient was discharged asymptomatic with normal cardiac enzymes, effective dual-chamber stimulation, and normalized systolic LV function.


Apical ballooning syndrome (takotsubo cardiomyopathy) after permanent dual-chamber pacemaker implantation.

Gardini A, Fracassi F, Boldi E, Albiero R - Case Rep Cardiol (2012)

Ventriculography showing typical takotsubo-like shape of LV.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008404&req=5

fig2: Ventriculography showing typical takotsubo-like shape of LV.
Mentions: A 75-year-old woman with history of hypertension and no previous cardiac symptoms was admitted for syncope and paroxysmal third-degree atrioventricular (AV) block. Preoperative evaluation revealed normal haematological tests, chest X-ray, and echocardiography. The EGC presented first-degree AV block, right bundle branch block, and left anterior fascicular block. A dual-chamber pacemaker (PM) with ventricular lead in the right ventricle (RV) apex was then implanted without procedural complications. On the night following the implant, the patient complained of repeated self-limited episodes of interscapular pain with mild dyspnoea. The day after the ECG showed sinus rhythm triggering PM ventricular stimulation with ST segment elevation in inferior and anterior leads. PM inhibition showed the preexisting intraventricular conduction disturbance with inferior and anterior ST segment elevation (Figure 1). Chest X-ray excluded pneumothorax. At echocardiogram, akinesia of the apical portions of the LV with reduced LV systolic function was observed. Cardiac biomarkers were slightly increased. The patient was treated with intravenous nitrates and antithrombotic agents due to suspicion of AMI. For the persistence of symptoms and ECG alterations, coronary angiography was performed with no evidence of significant coronary lesion or spasm. The ventriculography revealed ballooning of apical region with typical so-called takotsubo shape (Figure 2). In the following days, reduction in ST segment elevation and transient negative T wave were observed at ECG. At predischarge echocardiography, LV systolic function improved, and wall motion abnormalities disappeared. The patient was discharged asymptomatic with normal cardiac enzymes, effective dual-chamber stimulation, and normalized systolic LV function.

Bottom Line: Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function.No coronary lesions were found at angiography.The clinical and echocardiographic picture normalized at discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, S. Rocco Hospital, Ome, 25050 Brescia, Italy.

ABSTRACT
Apical ballooning syndrome, also called takotsubo cardiomyopathy, has been recently reported. It may mimic acute myocardial infarction and is typically observed in postmenopausal women after stressful events. A 75-year-old female after permanent dual chamber pacemaker implant complained of chest pain with repolarization alterations suggesting acute myocardial ischemia. Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function. The patient was treated with antithrombotic agents and intravenous nitrates. No coronary lesions were found at angiography. At ventriculography, a typical takotsubo-like shape of the left ventricle was observed. The clinical and echocardiographic picture normalized at discharge.

No MeSH data available.


Related in: MedlinePlus