However, left ventriculography revealed apical ballooning akinesis
with basal hyperkinesis during systole and reduced ejection fraction [Figure 2].
Caption: Figure 2: Parasternal short axis showing basal and apical akinesis
with preserved contractility of the mid ventricular segments.
According to the proposed criteria for diagnosis, TCM is characterized by presentation and electrocardiographic changes similar to those caused by myocardial infarction; however, atherosclerotic coronary artery disease is usually absent and the transient left ventricular apical akinesis
is usually beyond the distribution of a single coronary artery.
of mid left ventricular segments, the presence of stressful trigger, the absence of coronary artery lesion simultaneously with modest elevation in cardiac troponin and new electrocardiographic abnormalities are typical for this syndrome [5-7].
Mayo Clinic criteria, proposed in 2004 and later modified in 2008, include (a) transient hypokinesis, akinesis
, or dyskinesis in the LV mid-segments with or without apical involvement; RWMA extending beyond a single epicardial vascular distribution; the presence (often, but not always) of a stress trigger; (b) the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; (c) new electrocardiographic abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation of cardiac troponin levels in the serum; (d) the absence of pheochromocytoma or myocarditis.
Each segment was analyzed individually and scored by motion and systolic thickening as follows: 1 = normal/hyperkinesis, 2 = hypokinesis, 3 = akinesis
, 4 = dyskinesis, and 5 = aneurysmal.
A further echocardiogram on postoperative day 7 demonstrated akinesis
of the apex, distal anterolateral, septal and inferior walls with hyperdynamic contraction of the basal half of the ventricle.
Echocardiography showed a 5-cm pericardial mass adhering to the left lateral and posterior ventricular wall, resulting in severe akinesis
of the cardiac wall (Fig.
Takotsubo cardiomyopathy is a condition characterized by a sudden onset of cardiac symptoms along with transient left ventricular apical wall akinesis
and ballooning, electrocardiography (EKG) changes with ST elevation or depression, formation of abnormal Q-wave, and/ or elevation of cardiac enzymes in the absence of coronary artery disease.
There was akinesis
of the inferior wall and significant hypokinesis of the anterolateral wall.
Echocardiograms then and subsequently have shown a left ventricular ejection fraction of 20% with inferoposterior akinesis
, a restrictive filling pattern consistent with elevated left atrial and left ventricular end-diastolic pressures, severe mitral and tricuspid regurgitation, and a pulmonary arterial systolic pressure of 70 mm Hg.
On the ventriculography the left ventricular sizes were normal, akinesis
at the anterior and apical portion of the left ventricle, mild mitral regurgitation were seen.