Takotsubo syndrome with left ventricular thrombus: Prevention of systemic thromboembolism

Takotsubo syndrome (TTS) may at times be complicated by left ventricular (LV) thrombus with a potential risk of systemic embolism. Case 1: A 65-year-old woman presented with chest pain and electrocardiographic (ECG) features of deep T-wave inversions at leads V3-V6. A broad ballooning of mid-apical LV segments was demonstrated. Despite prophylactic anticoagulation, LV apical thrombus was detected 4 days later. She then experienced right coronary artery embolism, followed by posterior tibial artery embolism, both of which were successfully treated with thrombectomy. Case 2: A 63-year-old woman presented with consciousness disturbance and ECG features of ST-segment elevations at leads V3-V6. A broad ballooning of mid-apical LV segments and apical thrombus were demonstrated. Since LV thrombus became mobile 3 days after starting therapeutic anticoagulation, she underwent surgical removal of apical thrombus to prevent systemic embolism. An educational case series of TTS with LV thrombus is presented. In patients with TTS and LV thrombus, it is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started. In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.

•Takotsubo syndrome may be complicated by left ventricular (LV) thrombus, reportedly with an incidence rate of 1.3-2.3 %, with a potential risk of systemic embolism.•It is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started.•In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.