Successful Treatment of Cardiogenic Shock Due to Cardiac Rupture by Transient Focal Mid-Ventricular Takotsubo Cardiomyopathy

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BACKGROUND: Transient focal mid-ventricular Takotsubo syndrome (TTS) complicated by cardiogenic shock due to cardiac rupture has not been documented to our knowledge. CASE SUMMARY: A 76-year-old man was airlifted by helicopter emergency medical services. On admission, cardiogenic shock secondary to cardiac tamponade was diagnosed. Emergency pericardial fenestration was performed. Left ventricular angiography revealed severe dyskinesis in the mid-ventricular segment and hyperkinesis in both the basal and the apical regions. These findings initially raised suspicion for cardiac rupture secondary to a ventricular aneurysm. Repeat left ventricular angiography on day 4 showed complete resolution of wall motion abnormalities. A diagnosis of transient mid-ventricular stress cardiomyopathy complicated by cardiac rupture was made at that time. Surgical repair was performed. The patient was discharged home 56 days after admission. DISCUSSION: Partial or focal forms of TTS can mimic ventricular aneurysm, complicating diagnosis. TAKE-HOME MESSAGE: TTS should be considered a potential cause of cardiac rupture and included in the differential diagnosis by cardiologists.

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