Echocardiographic Diagnosis of Ventricular Free Wall Rupture Complicating Takotsubo Syndrome: A Case Report

Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy, is generally considered a reversible condition; however, it can be associated with fatal complications. We report a case of ventricular free wall rupture diagnosed by echocardiography in TTS triggered by an acute ischemic stroke. An 84-year-old man presented with left hemiparesis and was diagnosed with an acute right parietal infarction. On hospital day six, electrocardiography revealed diffuse ST-segment elevation without chest pain. Transthoracic echocardiography demonstrated akinesis of the mid-to-apical segments of the left ventricle with compensatory hyperkinesis of the basal segments, resulting in a typical apical ballooning pattern. These findings were inconsistent with a single coronary artery territory and supported the diagnosis of TTS. Coronary angiography revealed moderate coronary stenoses; however, left ventriculography demonstrated wall motion abnormalities that did not correspond to a single coronary distribution, further supporting the diagnosis of TTS. Several hours later, the patient developed sudden cardiac arrest. Transthoracic echocardiography revealed pericardial effusion with fibrin-like echoes, suggestive of ventricular free wall rupture. Despite resuscitative efforts, the patient died.