Recurrent takotsubo with prolonged QT and torsade de pointes and left ventricular thrombus

Abstract

Takotsubo cardiomyopathy, also known as "takotsubo syndrome," refers to transient apical ballooning syndrome, stress cardiomyopathy, or broken heart syndrome and is a recently recognized syndrome typically characterized by transient and reversible left ventricular dysfunction that develops in the setting of acute severe emotional or physical stress. Increased catecholamine levels have been proposed to play a central role in the pathogenesis of the disease, although the specific pathophysiology of this condition remains to be fully determined. At present, there have been very few reports of recurrent takotsubo cardiomyopathy. In this case report, we present a patient with multiple recurrences of takotsubo syndrome triggered by severe emotional stress that presented with recurrent loss of consciousness, QT prolongation, and polymorphic ventricular tachycardia (torsade de pointes) and left ventricular apical thrombus.

Keywords: Apical ballooning; QT prolongation; Recurrence; Takotsubo; Thrombus; Torsade de pointes; Ventricular dysfunction.

Figure 1

Prolonged QT.

Figure 2

Torsade de pointes.

Figure 3

Left ventricular apical ballooning.

Figure 4

Left ventricular apical thrombus.

Figure 5

Left ventricular apical clot resolved.