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Unexpected outcome (positive or negative) including adverse drug reactions
Case report
A biventricular takotsubo cardiomyopathy complication: large thrombus formation to stroke in 150 min
  1. Eric W Moffet1,2,
  2. Gurjaspreet Kaur Bhattal1,
  3. Alexis N Simpkins3 and
  4. John W Petersen4
  1. 1Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
  4. 4Cardiology, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Eric W Moffet; emoffet{at}wisc.edu

Abstract

A 67-year-old postmenopausal African American woman presented with biventricular takotsubo cardiomyopathy (TTC)—evidenced by transthoracic echocardiography (TTE) showing apical akinesis of both left and right ventricles in the absence of obstructive coronary artery disease on left heart catheterisation. On the 4th hospital day, she experienced acute left facial droop, dysarthria and dysphagia. CT of the head showed a wedge infarct of the right middle cerebral artery territory. Cardioembolism was presumed after intracranial and extracranial sources of thromboembolism were ruled out. Intravenous tissue plasminogen activator (tPA) was administered with resolution of symptoms. She was later discharged without neurological deficits. Crucially, repeat TTE after tPA infusion revealed a left ventricular mass concerning for thrombus. TTE 150 min prior to stroke onset was devoid of a mass. This case uniquely illustrates the potential for rapid thrombus formation and embolism in patients with TTC. As such, it emphasises the high index of suspicion required for management of these patients.

  • Stroke
  • Cardiovascular medicine

https://doi.org/10.1136/bcr-2020-235957

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    Footnotes

    • Contributors All authors were involved in the acute in-hospital care of the patient. EWM drafted the manuscript for intellectual content, edited drafts and figures for continuity, and prepared the final manuscript submission. GKB drafted the manuscript for intellectual content, edited drafts, and created figure 1. ANS provided critical review of the manuscript and created figure 2. JWP conducted critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.