An Exceptional Cause of Acute Right Heart Failure: Isolated Right Ventricular Takotsubo Syndrome

Abstract

We describe a patient with of acute right ventricular dysfunction secondary to right ventricular isolated Takotsubo syndrome (TTS). The importance of appropriate differential diagnosis for acute right ventricular dysfunction differential diagnosis of acute right ventricular dysfunction and the differences in diagnosis and management of right ventricular TTS and typical left ventricular TTS are highlighted. (Level of Difficulty: Intermediate.).

Keywords: AMI, acute myocardial infarction; ECG, electrocardiogram; LV, left ventricle; MRI, magnetic resonance imaging; RV, right ventricle; TTS, Takotsubo syndrome; Takotsubo syndrome; cardiac magnetic resonance; cardiogenic shock; right ventricle; stress cardiomyopathy.

Graphical abstract

Figure 1

Initial ECG (A) ECG at admission showing precordial leads with no repolarization abnormalities. (B) Right-sided precordial leads (right) showing nondeep negative T waves in leads V₃R to V₆R. ECG = electrocardiogram.

Figure 2

Right Coronary Angiography, Chest CT Scan, and Cardiac MRI (Top row) Angiography (left) showing normal right coronary artery (RCA) with no presence of lesions and chest computed tomographic (CT) scan (right) showing no evidence of pulmonary thromboembolism and normal diameter pulmonary trunk. (Middle, bottom rows) Four-chamber cine images by cardiac magnetic resonance imaging (MRI) in diastole (left) and systole (right) with dilated right ventricle (RV) and dyskinesia of the RV free wall at admission and recovery of the volumes and contractility of the RV at cardiac MRI performed 10 days after. LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; RVEDV = right ventricular end-diastolic volume; RVEF = right ventricular ejection fraction.

Figure 3

Evolutionary ECG ECG performed on day 2 showing evolutionary negative T waves in leads V₁ to V₄ with slight QT-interval prolongation. ECG = electrocardiogram.