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Takotsubo cardiomyopathy with left ventricular thrombus presenting as critical limb ischaemia

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ABSTRACT

Takotsubo cardiomyopathy (TC) is a rare condition, characterized by acute left ventricular (LV) dysfunction in the absence of flow-limiting coronary artery disease, usually provoked by a physical or emotional stressor. The condition is far more common in women. The commonest presenting symptoms in patients with TC are chest pain and shortness of breath, often mimicking an acute coronary syndrome. A number of complications of TC are recognized, and very rarely patients experience cardioembolic phenomena secondary to LV thrombus formation in TC. We present the case of a 48-year-old lady presenting with peripheral limb ischaemia, subsequently found to have an LV thrombus secondary to TC. Diagnosis of TC was made challenging by the absence of chest pain. She required urgent arterial embolectomy and was treated with 6-month oral anticoagulation therapy. She was also commenced on beta-blocker and angiotensin-converting enzyme inhibitor treatment for the management of LV dysfunction.

No MeSH data available.


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Twelve-lead ECG. This demonstrates a sinus tachycardia, with ST-segment elevation in leads V3–V5. There is T-wave inversion in leads V3–V6.
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omw051F1: Twelve-lead ECG. This demonstrates a sinus tachycardia, with ST-segment elevation in leads V3–V5. There is T-wave inversion in leads V3–V6.

Mentions: She was hypotensive (blood pressure 79/43 mmHg), tachycardic (heart rate 130 beats per minute) and tachypnoeic (respiratory rate 30 breaths per minute) on admission. There was no fever or hypoxia. She was visibly uncomfortable at rest, due to marked right leg pain and dyspnoea. Examination of her right leg revealed a swollen, cold, pale and tender extremity with no palpable popliteal, posterior tibial or dorsalis pedis pulses. Bilateral basal inspiratory crackles were audible on chest auscultation. Her electrocardiogram (ECG) on admission showed a sinus tachycardia with anterior ST-segment elevation (Fig. 1), and bilateral interstitial oedema was evident on her chest X-ray.Figure 1:


Takotsubo cardiomyopathy with left ventricular thrombus presenting as critical limb ischaemia
Twelve-lead ECG. This demonstrates a sinus tachycardia, with ST-segment elevation in leads V3–V5. There is T-wave inversion in leads V3–V6.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036842&req=5

omw051F1: Twelve-lead ECG. This demonstrates a sinus tachycardia, with ST-segment elevation in leads V3–V5. There is T-wave inversion in leads V3–V6.
Mentions: She was hypotensive (blood pressure 79/43 mmHg), tachycardic (heart rate 130 beats per minute) and tachypnoeic (respiratory rate 30 breaths per minute) on admission. There was no fever or hypoxia. She was visibly uncomfortable at rest, due to marked right leg pain and dyspnoea. Examination of her right leg revealed a swollen, cold, pale and tender extremity with no palpable popliteal, posterior tibial or dorsalis pedis pulses. Bilateral basal inspiratory crackles were audible on chest auscultation. Her electrocardiogram (ECG) on admission showed a sinus tachycardia with anterior ST-segment elevation (Fig. 1), and bilateral interstitial oedema was evident on her chest X-ray.Figure 1:

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Takotsubo cardiomyopathy (TC) is a rare condition, characterized by acute left ventricular (LV) dysfunction in the absence of flow-limiting coronary artery disease, usually provoked by a physical or emotional stressor. The condition is far more common in women. The commonest presenting symptoms in patients with TC are chest pain and shortness of breath, often mimicking an acute coronary syndrome. A number of complications of TC are recognized, and very rarely patients experience cardioembolic phenomena secondary to LV thrombus formation in TC. We present the case of a 48-year-old lady presenting with peripheral limb ischaemia, subsequently found to have an LV thrombus secondary to TC. Diagnosis of TC was made challenging by the absence of chest pain. She required urgent arterial embolectomy and was treated with 6-month oral anticoagulation therapy. She was also commenced on beta-blocker and angiotensin-converting enzyme inhibitor treatment for the management of LV dysfunction.

No MeSH data available.


Related in: MedlinePlus