Takotsubo Cardiomyopathy

 

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The initial parasternal long axis shows a clear wall motion abnormality of the distal inferolateral wall and anteroseptum. Note that the basal segments contract quite well. In this view the apex is not well seen as it is in the apical views.

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The four chamber shows now more clearly that a large apical segments of the lateral and septal wall as well as the true apex is hypokinetic. The walls are not thinned. RV function also appears preserved.

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A two chamber view shows involvement of the distal inferior wall and anterior walls.

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This apical long axis here confirms the findings from the parasternal views above. Taken together, this wall motion abnormality pattern is highly suggestive of takotsubo cardiomyopathy wherein there is hypokinesis of the apical segments and apex with sparing of the base. In the appropriate clinical context or scenario, coronary artery disease  should be ruled out as this could also be a large "wrap around" LAD infarct, where in the LAD wraps around the apex.

A

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B

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C

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D

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Finally the parasternal short axis windows shows how wall motion is normal at the base and mid LV (Panels A and B) but markedly abnormal as we get toward the apex (Panels C and D)