Rapid Formation of Left Ventricular Giant Thrombus With Takotsubo Cardiomyopathy
2007; Lippincott Williams & Wilkins; Volume: 115; Issue: 23 Linguagem: Inglês
10.1161/circulationaha.106.673947
ISSN1524-4539
AutoresKensuke Kimura, Yumeko Tanabe-Hayashi, Shigetaka Noma, Keiichi Fukuda,
Tópico(s)Takotsubo Cardiomyopathy and Associated Phenomena
ResumoHomeCirculationVol. 115, No. 23Rapid Formation of Left Ventricular Giant Thrombus With Takotsubo Cardiomyopathy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBRapid Formation of Left Ventricular Giant Thrombus With Takotsubo Cardiomyopathy Kensuke Kimura, MD, Yumeko Tanabe-Hayashi, MD, Shigetaka Noma, MD, PhD and Keiichi Fukuda, MD, PhD Kensuke KimuraKensuke Kimura From the Department of Regenerative Medicine and Advanced Cardiac Therapeutics, Keio University School of Medicine, Tokyo, Japan (K.K., K.F.); Bridgestone Laboratory of Developmental and Regenerative Neurobiology, Keio University School of Medicine, Tokyo, Japan (K.K.); and Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (Y.T.-H., S.N.). , Yumeko Tanabe-HayashiYumeko Tanabe-Hayashi From the Department of Regenerative Medicine and Advanced Cardiac Therapeutics, Keio University School of Medicine, Tokyo, Japan (K.K., K.F.); Bridgestone Laboratory of Developmental and Regenerative Neurobiology, Keio University School of Medicine, Tokyo, Japan (K.K.); and Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (Y.T.-H., S.N.). , Shigetaka NomaShigetaka Noma From the Department of Regenerative Medicine and Advanced Cardiac Therapeutics, Keio University School of Medicine, Tokyo, Japan (K.K., K.F.); Bridgestone Laboratory of Developmental and Regenerative Neurobiology, Keio University School of Medicine, Tokyo, Japan (K.K.); and Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (Y.T.-H., S.N.). and Keiichi FukudaKeiichi Fukuda From the Department of Regenerative Medicine and Advanced Cardiac Therapeutics, Keio University School of Medicine, Tokyo, Japan (K.K., K.F.); Bridgestone Laboratory of Developmental and Regenerative Neurobiology, Keio University School of Medicine, Tokyo, Japan (K.K.); and Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (Y.T.-H., S.N.). Originally published12 Jun 2007https://doi.org/10.1161/CIRCULATIONAHA.106.673947Circulation. 2007;115:e620–e621A 54-year-old woman diagnosed with sarcoidosis with lung involvement was admitted because of faintness associated with complete atrioventricular block. Cardiac catheterization showed normal coronary arteries and preserved left ventricular systolic function (online-only Supplemental Movie I), but endomyocardial biopsy revealed cardiac involvement. A pacemaker was implanted uneventfully, but she perceived the operation to be particularly stressful. Three hours after the operation, routine follow-up echocardiography revealed akinesis of the left ventricular apical wall, but no apical thrombi (Figure 1; Supplemental Movies II and III). She had no symptoms, but her ECG showed artificial right ventricular apical pacing of 70 bpm with additional ST-segmental elevation in leads II, III, aVF, and V3 through V6. There were no significant changes in serum markers of cardiac damage (white blood cells, creatine kinase, creatine kinase-MB, and cardiac troponin T), but brain natriuretic peptide was elevated to 680 pg/mL (reference range <40 pg/mL). Coronary angiography performed 2 days after the operation revealed normal coronary arteries, but left ventriculography demonstrated apical and mid–left ventricular ballooning with augmented contraction of the basal segment, indicating that she was suffering from emotional stress–induced Takotsubo cardiomyopathy. Surprisingly, a giant thrombus, which had formed within 2 days, was detected at the apex (Figure 2; Supplemental Movies IV and V). Heparin and warfarin were started concurrently. Fortunately, the thrombus completely disappeared within 7 days, and left ventricular function recovered within 14 days, without any embolic events (Supplemental Movie VI). To the best of our knowledge, this is the first description of Takotsubo cardiomyopathy associated with rapid formation of an apical giant thrombus. Clinicians should note the possibility of rapid thrombus formation and consider the use of anticoagulation therapy in the management of Takotsubo cardiomyopathy. Download figureDownload PowerPointFigure 1. Transthoracic echocardiograms showing left ventricular apical dysfunction without any thrombus at 3 hours after operation. A, Apical 4-chamber view. B, Two-chamber view. LV indicates left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; and PML, pacemaker lead.Download figureDownload PowerPointFigure 2. Left ventriculography (right anterior oblique view) showing left ventricular ballooning in the mid and apical segments, with vigorous contraction of the basal segment (arrowheads), and a giant thrombus in the apex of the left ventricle (arrows). LV indicates left ventricle.The online-only Data Supplement, which contains Movies I through V, can be found at http://circ.ahajournals.org/cgi/content/full/115/23/e620/DC1.DisclosuresNone.FootnotesCorrespondence to Keiichi Fukuda, MD, PhD, Department of Regenerative Medicine and Advanced Cardiac Therapeutics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. 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Case Reports and Review of the Literature, Frontiers in Oncology, 10.3389/fonc.2022.875391, 12 June 12, 2007Vol 115, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.673947PMID: 17562963 Originally publishedJune 12, 2007 PDF download Advertisement SubjectsAnticoagulantsCardiomyopathy
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