A case of biventricular Takotsubo cardiomyopathy with hyperthyroidism as a basic disease

Abstract

Takotsubo cardiomyopathy (TTC) has generally good prognosis and it is characterized by transient contractility disorder of the apical part of the left ventricle (LV) with the hypercontraction of the basal LV. Clinically, TTC mimics acute coronary syndrome but there is no coronary artery disease. Recently, many atypical types involving basal, midventricle, and right ventricle (RV) have been described, and reversible LV hypertrophy during the recovery phase from TTC has also been reported. We report the case of a woman in her 80’s presenting with biventricular TTC. Transient LV apical hypertrophy was observed by serial echocardiography. Right ventricular involvement may correlate with very severe clinical conditions because of serious RV heart failure in addition to LV heart failure. Thus, the detection of RV disorder at the onset of TTC is very important and useful for its treatment. Careful observation by echocardiography is needed so as not to miss abnormal RV contraction. This case is considered to cause hyperthyroidism. Commonly, TTC is triggered by intense physical or mental stress, but its etiology is still unknown. Hyperthyroidism has been described in association with TTC. We should check thyroid function to investigate the etiology of TTC because the heart is easily affected by the thyroid hormone.