Takotsubo cardiomyopathy with Basal Hypertrophy and outflow obstruction in a patient with bowel ischemia

Abstract

Basal septal hypertrophy is a rare and unique anatomical finding associated with hypertrophic cardiomyopathy (HCM). It is also described as a sigmoid hypertrophy and is linked with aging and chronic hypertension. Takotsubo cardiomyopathy is a transient cardiomyopathy that occurs during periods of high physical or emotional stress. Its occurrence with HCM is relatively common; however, this presentation occurs more often with the classic asymmetrical septal hypertrophy or the apical variant. This case demonstrates its coexistence with isolated sigmoid hypertrophy in an elderly, hypertensive female with severe ischemic bowel disease.

Keywords: Basal hypertrophy; bowel ischemia; takotsubo.

Figure 1

EKG showing ST-segment elevation on anteroseptal leads with reciprocal changes on inferolateral leads

Figure 2

Two-chamber view with color Doppler showing severe eccentric mitral regurgitation Jet

Figure 3

Two-chamber view showing hypokinesis from mid anterior wall to apex

Figure 4

Left ventriculogram showing ventricular apical ballooning

Figure 5

Pressure tracing during pull back showing the increased LVOT gradient

Figure 6

Chamber View showing resolution of apical ballooning and wall motion abnormalities