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Left ventricular free wall rupture in transient left ventricular apical ballooning
Yoshikazu Ohara1, Yoshikazu Hiasa, Shinobu Hosokawa
1Division of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan. yoshio@tokushima-med.jrc.or.jp
Summary
Transient left ventricular apical ballooning, typically benign, can rarely lead to fatal cardiac tamponade due to left ventricular free wall rupture. This case highlights a rare but severe complication of this cardiac condition.
Area of Science:
- Cardiology
- Cardiovascular Medicine
Background:
- Transient left ventricular apical ballooning (Takotsubo cardiomyopathy) is often associated with a good prognosis.
- Acute myocardial infarction is a common cause of chest pain, typically involving coronary artery blockages.
Observation:
- A 79-year-old woman presented with chest pain suggestive of acute anterior myocardial infarction.
- Coronary angiography revealed no obstructive coronary artery disease, but left ventriculography showed apical ballooning and basal hyperkinesis, leading to a diagnosis of transient left ventricular apical ballooning.
Findings:
- Despite the generally favorable prognosis of transient left ventricular apical ballooning, the patient developed cardiac tamponade and cardiopulmonary arrest 7 days after diagnosis.
- Autopsy confirmed left ventricular free wall rupture as the cause of cardiac tamponade, a very rare complication.
Implications:
- This case underscores the potential for severe, life-threatening complications, such as free wall rupture, even in cases initially diagnosed as transient left ventricular apical ballooning.
- Clinicians should remain vigilant for rare but catastrophic complications of transient left ventricular apical ballooning, emphasizing the need for close monitoring and prompt management.