warfarin and Takotsubo-Cardiomyopathy

Takotsubo cardiomyopathy is characterized by transient systolic dysfunction of the apical and mid segments of the left ventricle in the absence of obstructive coronary artery disease. Intraventricular thrombus formation is a rare complication of Takotsubo cardiomyopathy and current data almost exclusively consists of isolated case reports and a few case series. Here we describe a case of Takotsubo cardiomyopathy with formation of an apical thrombus within 24 h of symptom onset, which has been reported in the literature only once previously, to the best of our knowledge. We have reviewed the available literature that may aid clinicians in their approach to the condition, since no published guidelines are available.. A 68-year-old Sri Lankan female presented to a local hospital with chest pain. Electrocardiogram (ECG) showed ST elevation, and antiplatelets, intravenous streptokinase and a high dose statin were administered. Despite this ST elevation persisted; however the coronary angiogram was negative for obstructive coronary artery disease. Echocardiogram revealed hypokinesia of the mid and apical segments of the left ventricle with typical apical ballooning and a sizable apical thrombus. She had recently had a viral infection and was also emotionally distressed as her sister was recently diagnosed with a terminal cancer. A diagnosis of Takotsubo cardiomyopathy was made and anticoagulation was started with heparin and warfarin. The follow up echocardiogram performed 1 week later revealed a small persistent thrombus, which had completely resolved at 3 weeks.. Though severe systolic dysfunction is observed in almost all the patients with Takotsubo cardiomyopathy, intraventricular thrombus formation on the first day of the illness is rare. The possibility of underdiagnosis of thrombus can be prevented by early echocardiogram in Takotsubo cardiomyopathy. The majority of reports found in the literature review were of cases that had formed an intraventriclar thrombus within the first 2 weeks, emphasizing the importance of follow up echocardiography at least 2 weeks later. The management of a left ventricular thrombus in Takotsubo cardiomyopathy is controversial and in most cases warfarin and heparin were used for a short duration.

Topics: Aged; Anticoagulants; Coronary Angiography; Echocardiography; Electrocardiography; Female; Heparin; Humans; Remission Induction; Systole; Takotsubo Cardiomyopathy; Thrombosis; Time Factors; Treatment Outcome; Ventricular Function, Left; Warfarin

We present the case of a 57-year-old female with no significant history of cardiac disease admitted to our service with stress-induced cardiomyopathy (Takotsubo's cardiomyopathy). Admission echocardiography with contrast showed a non-mobile apical-filling defect, consistent with laminar thrombus. After 1 month of anticoagulation with warfarin (bridged with inpatient intravenous heparin), follow-up echocardiography with contrast showed resolution of the thrombus. Although reported in the literature, to our knowledge, there are no consensus guidelines for the surveillance and treatment of left ventricular thrombus in patients with Takotsubo's cardiomyopathy. An awareness of this adverse effect and its treatment implications is imperative for any clinician caring for these patients.

Topics: Anticoagulants; Echocardiography; Female; Heart Ventricles; Humans; Middle Aged; Takotsubo Cardiomyopathy; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Topics: Anticoagulants; Contrast Media; Coronary Thrombosis; Echocardiography; Heparin; Humans; Pulmonary Embolism; Takotsubo Cardiomyopathy; Warfarin