Case-Based Session: Cases from Outside Europe: Friday 5 December 2014, 15:30-16:30 * Location: Agora

European Heart Journal - Cardiovascular Imaging（2014）

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Abstract

An 89-year-old woman experienced sudden dyspnea and chest pain 3 days after total hip replacement surgery.Electrocardiography revealed sinus tachycardia and T-wave inversion in leads III, aVF and V1 through V4.The patient had a slightly elevated troponin T level.Echocardiography showed right ventricular (RV) enlargement and akinesis of the RV free wall, with preserved wall motion of the RV apex.Left ventricular wall motion was preserved.Cardiac magnetic resonance imaging also showed the wall motion abnormality to be localized in the free wall of the RV.Late gadolinium enhancement was absent in both left ventricular and the RV wall.Pulmonary embolism and coronary artery disease as a cause of the RV wall motion abnormality were excluded by a contrast enhanced multidetector computed tomography scan.She was diagnosed as an isolated RV TakoTsubo cardiomyopathy (TC) and was conservatively managed.On postoperative day 11, followup echocardiography showed improvement in wall motion of the RV.Although TC was first recognized as LV apical ballooning induced by emotional and/or physical stress, TC with RV involvement has been reported as a possible variant in about one-fourth patients with TC.In our present case, isolated RV wall motion abnormality was clearly documented by both echocardiography and cardiac magnetic resonance imaging.Thus, isolated RV TC may be a new, emerging variant of TC.

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