case_images: PMC4971286_01
case_images: (a) EKG on admission with normal QTc of 446 ms. (b) Close-up of lead V2.
case_images: CRIC2016-2384752.001.jpg
case_images: PMC4971286_01_CRIC2016-2384752.001.jpg
case_images: fig1
case_images: Since admission, the patient had progressive T wave changes (Figures 1 and 2).
case_images: (a) After 12 hours of admission, progressive T wave inversion; the QTc is being prolonged of 491 ms. (b) Close-up of lead II.
case_images: CRIC2016-2384752.002.jpg
case_images: PMC4971286_01_CRIC2016-2384752.002.jpg
case_images: fig2
case_images: Since admission, the patient had progressive T wave changes (Figures 1 and 2).
case_images: After 22 hours of admission, telemetry strip showing TdP.
case_images: CRIC2016-2384752.003.jpg
case_images: PMC4971286_01_CRIC2016-2384752.003.jpg
case_images: fig3
case_images: After the patient was admitted to the coronary care unit, the patient was found to be in torsades de pointes (TdP) pulseless polymorphic ventricular tachycardia (Figure 3).
case_images: (a) After TdP, progressive T wave inversion and QTc prolongation of 691 ms. (b) Close-up of lead II.
case_images: CRIC2016-2384752.004.jpg
case_images: PMC4971286_01_CRIC2016-2384752.004.jpg
case_images: fig4
case_images: T wave inversions worsened with evidence of prolonged QTc (Figure 4). The patient was intubated to maintain and protect airways.
case_images: Echocardiographic evidence of classic takotsubo cardiomyopathy, the apical type. (a) represents diastole and (b) represents systole.
case_images: CRIC2016-2384752.005.jpg
case_images: PMC4971286_01_CRIC2016-2384752.005.jpg
case_images: fig5
case_images: The patient was scheduled for a transthoracic echocardiogram (TTE) and a cardiac catheterization the following day. The TTE revealed a reduced left ventricular ejection fraction (25%-30%) with apical wall motion abnormalities consistent with a great likelihood of classic takotsubo cardiomyopathy, the apical type (Figure 5).
case_images: Angiogram reveals normal coronary arteries.
case_images: CRIC2016-2384752.006.jpg
case_images: PMC4971286_01_CRIC2016-2384752.006.jpg
case_images: fig6
case_images: A coronary angiogram was performed a few days later and did not show any significant coronary artery disease (Figure 6).
case_images: Echocardiographic evidence of normalization of left ventricular ejection fraction. (a) represents diastole and (b) represents systole.
case_images: CRIC2016-2384752.007.jpg
case_images: PMC4971286_01_CRIC2016-2384752.007.jpg
case_images: fig7
case_images: Patient had repeated echocardiogram three months later and left ventricular ejection fraction improved to >55% without any wall motion abnormality (Figure 7).