[De novo left ventricular thrombus during tako-tsubo cardiomyopathy].

HISTORY AND CLINICAL FINDINGS: A 70-year-old woman complained of persistent angina pectoris and exertional dyspnoea after a fierce row with a dog owner. Five days after the conflict she visited our clinic.

INVESTIGATIONS: The ECG showed T-wave inversions across the inferior and anterior leads as well as a prolonged QTc interval (490 ms). NTproBNP was elevated (6733 ng/l) while troponin T was normal. Echocardiography and ventriculography during cardiac catheterisation demonstrated an impaired left ventricular function (EF 55 %) with apical akinesia. Coronary artery disease was ruled out by coronary angiography. Based on these findings stress-related cardiomyopathy (Tako-tsubo syndrome) was diagnosed.

TREATMENT AND CLINICAL COURSE: Guideline-based therapy of heart failure was performed. At control examination 13 days after the initial event left ventricular function had improved but now a new left ventricular apical thrombus was detected. Therefore, oral anticoagulation therapy was started.

CONCLUSION

In cases of tako-tsubo cardiomyopathy with apical akinesia it should be noted that a left ventricular thrombus can develope within few days.