A Case of Takotsubo Cardiomyopathy Complicated by Transient Cataplectic Attack of Upper Limb

Abstract

A 60 year-old women realized chest pain during an argument. Next day, she visited a clinic, and was transferred to our hospital due to suspected acute coronary syndrome with ECG T-wave changes. Because coronary angiogram showed no significant stenosis, whereas left ventriculography demonstrated akinesis in the apical and mid-ventricular region and hyperkinesis in the basal area, we diagnosed as Takotsubo cardiomyopathy. Anticoagulation therapy was started as soon as possible because left ventricle (LV) apical wall motion was severely reduced. Nevertheless, she suffered a bout of cataplectic attack of upper limb at the day of admission. Head MRI demonstrated high intensity area located near right lateral cerebroventricle. At the same time, echocardiography also demonstrated improvement of LV apical and mid-ventricular wall motion. After that, intensification of anticoagulation therapy and start of rehabilitation were performed. She was discharged without paralysis after ten days of hospitalization. In this case, it took comparatively a long time for her to be diagnosed as Takotsubo cardiomyopathy from chest pain. Therefore, it seemed more likely that small thrombus was formed in LV apex. Because LV wall motion improved earlier than usual, free thrombus from LV wall caused cerebral embolism. This case suggested that intensification of anticoagulation therapy was needed when it took a long time to be diagnosed as Takotsubo cardiomyopathy from onset.