Table 1.
Reported cases with cardiac rupture in takotsubo cardiomyopathy patients (Ovid MEDLINE, 2018).
| Authors | Age (in years) | Gender | Clinical presentation | EKG finding | Troponin (ng/ml) | ECHO findings | Catheterization findings | Outcomes | Autopsy findings |
|---|---|---|---|---|---|---|---|---|---|
| Kumar et al. [9] | 62 | Female | Weakness and lightheadedness | ST elevation in I, II, and V5-V6 | 11.64 | EF 30% and severely reduced LV systolic function in mid and distal segments and preserved at basal segments | Nonstentable 50-75% stenosis at mid LAD artery | Death | Slit-like rupture at the mid portion of the posterior ventricular wall |
| Zalewska-Adamiec et al. [11] | 74 | Female | Chest pain | Sinus rhythm with QS complex and ST segment elevation in V2-V6 | 2.041 | Contractile disturbances in the apex and hyperkinesis of basal segments with EF 56% and cardiac tamponade | No significant stenosis | Surgical repair and good condition on discharge | Not applicable |
| Kudaiberdiev et al. [12] | 63 | Female | Chest pain, lightheadedness, dyspnea | Q waves in III and aVF, T wave inversions in lead II, III, and aVF, and ST-T abnormalities in V5-V6 | 0.0 | LV dilatation EF (35%) moderate MR, hypoakinesia and thinning of LV inferolateral wall with rupture and cross-over blood shunt through two defects into the pericardium | Patent coronary arteries | Surgical repair and good condition on discharge | Not applicable |
| Sung et al. [13] | 73 | Female | Chest pain and dyspnea | ST elevation in V2-V5 | 1.3 | Akinesis of mid to apical left ventricle with EF of 58% | Patent coronary arteries | Death | Not performed |
| Yoshida et al. [5] | 78 | Female | Chest pain and dyspnea | RBBB and ST elevation in V2-V6 with QS pattern | Not mentioned | Apical kinesis with wall thinning and massive pericardial effusion | Patent coronary arteries | In good condition after discharge | Not applicable |
| Indorato et al. [1] | 70 | Female | Chest pain and nausea | Not done | Not done | Not performed | Not performed | Death. Patient died en route to hospital | Hemorrhagic infarction of LV apex. 0.4 cm line of ruptured myocardium from anterior to posterior wall at the apex |
| Shams [14] | 73 | Male | Clinical features of pulmonary edema | Sinus tachycardia with Q waves and ST elevation in inferior leads and depression in anterolateral leads | 2.840 | Left ventriculography: akinesis in the middle and basal-inferior wall and in broad band of mid anterior, mid lateral, and mid septal parts of the left ventricle and hemopericardium. Bedside, limited echo shows cardiac tamponade | Stenosis of all three major arteries. No signs of coronary occlusion | Death | Hemopericardium, perforation of LV free wall at upper posterior part |
| Kurisu and Inoue [2] | 81 | Female | Unconsciousness | ST segment elevation in I, II, III, aVF, and V2-V6 | Not mentioned | Apical akinesia and basal hyperkinesis | Patent coronary arteries | Death | Not performed |
| Sacha et al. [6] | 81 | Female | Chest pain | Diffuse ST elevation in the precordial and limb leads | 1.55 | Balloon-like LV motion abnormalities with akinesis from mid to apical portions and hyperkinesis of base | No coronary artery disease | Death | Hemopericardium with an LV free wall rupture measuring 10 mm in the apical region and no patent coronary arteries. Inside the heart, there was a mural thrombus in the apical area |
| Jaguszewski et al. [15] | 82 | Female | Chest pain | St segment elevation from V1 to V5 | 14.82 | Abnormal LV contraction with apical ballooning pattern with EF of 55% | Patent coronary arteries | Death | Wide penetrating apical rupture as well as 1500 ml of thrombi and liquid blood in the pericardium |
| Shinozaki et al. [16] | 90 | Female | Chest pain | ST segment elevation in aVL and V1-V4 | Not mentioned | LV apical akinesis and hyperkinesis of base | Intact coronary arteries | Death | Not mentioned |
| Akashi et al. [8] | 70 | Female | Chest discomfort | ST elevation in I, II, III, aVL, aVF, and V2-V6 | Not mentioned | Apical akinesis and basal hyperkinesis with EF of 51% | Normal coronary arteries | Death | Not performed |
| Showkathali et al. [17] | 86 | Female | Chest pain | ST segment elevation in anterolateral and inferior leads | Not mentioned | Shows TCM and no intraventricular gradient | Normal RCA and mild atheromatous LAD artery | Death | Not mentioned |
| Yamada et al. [18] | 71 | Female | Shoulder and back pain | St segment elevation in leads V4-V6 and abnormal Q waves in leads V4-V5 | Not mentioned | Left ventricular apical wall akinesis. Hyperkinesis in the basal wall with mitral valve systolic anterior wall motion | No coronary artery stenosis | Death | Not performed |
| Stöllberger et al. [19] | 71 | Female | Generalized tonic clonic seizure | ST segment elevation in II, II, avF, V5, and V6 | Trop-T positive | Left ventricular apical wall, apical septum, and apical posterior wall akinesia and small pericardial effusion | Normal coronary arteries | Death | 5 mm left ventricular rupture in the apicoposterior region |
| Ohara et al. [20] | 79 | Female | Chest pain | ST segment elevation in 1, aVL, and V1-V5; depression in leads III and avF; and abnormal Q wave in V1-V4 | Not mentioned | Akinesis of the left ventricular apical wall | Patent coronary arteries | Death | Rupture in the anterior portion of the left ventricle, patent coronary arteries, and hemopericardium |
| Mafrici et al. [21] | 87 | Female | Chest pain and dyspnea | ST segment elevation in inferior leads and V2-V6 | Trop-T: 20 | Apical dyskinesis with hyperkinesis of left ventricular basal segment | Patent coronary arteries | Death | Not performed |
| Ishida et al. [22] | 67 | Female | Chest pain | ST segment elevation in I, avL, and V2-V5 | Not mentioned | Apical ballooning, basal hyperkinesis, and left ventricular outflow pressure gradient of 110 mmHg associated with systolic anterior movement of anterior mitral leaflet | Extensive akinesis from the apex to mid portion | Surgical repair to correct the cardiac rupture slit | Not applicable |
| Leva et al. [23] | 65 | Female | Chest pain and dyspnea | ST segment elevation in anterior leads | Not mentioned | Akinesis from mid to apical LV and basal hyperkinesis, EF of 30% | No significant stenosis of epicardial coronary arteries | Death | Not mentioned |
| Iskander et al. [24] | 77 | Female | Unconsciousness, chest pain, and dyspnea | ST segment. Elevation in leads I, aVL, and V2-V6 | Trop-T: 3.60 | EF of 25%. Severe dyskinesis of anterolateral wall of LV, no LVOT obstruction | No coronary artery obstruction with slow flow down the LAD | Death | Fresh clot on epicardial surface, slit-like rupture on anteroapical surface of LV |
| Present case | 75 | Female | Chest pain and dyspnea | Sinus rhythm, no ST segment elevation, poor R wave progression | 6.80 | EF of 30-35%, severe hypokinesis of apical LV, and asymmetric hypertrophy of the basal septum | Not performed | Death | Hemopericardium, patent epicardial coronary arteries, slit-like 1 cm × 0.8 cm rupture of the anterior wall of LV |
Abbreviations: LV: left ventricle; LAD: left anterior descending artery; RCA: right coronary artery; EF: ejection fraction; TCM, takotsubo cardiomyopathy; LVOT: left ventricular outflow tract obstruction; LAD: left anterior descending artery.