About the Cover
ON THE COVER A 59-year-old postmenopausal woman with a history of controlled systemic lupus erythematosus visited our hospital with chest pain and dyspnea. Sixty hours before, she had a terrible quarrel with her daughter and had experienced chest pain immediately after this event. Her chest X-ray showed pulmonary congestion with mild cardiomegaly and electrocardiography demonstrated ST-segment elevation in leads I, II, III, aVF, and V2 through V6. Emergency coronary arteriography was normal, left ventriculography demonstrated left ventricular apical ballooning, and a thrombus was found in the apex of the left ventricle. Then, she received a diagnosis of Takotsubo cardiomyopathy and was given medical care for heart failure and anticoagulation therapy for the thrombus. Apical ballooning improved 10 days later and the thrombus disappeared 3 months later in echocardiography, without any embolic events. In Takotsubo cardiomyopathy, several complcations have been reported, but ventricular thrombus, which is caused by apical akinesis, is not well understood. Although anticoagulation therapy is recommended for the management of Takotsubo cardiomyopathy, there has been only a small amount of evidence of ventricular thrombus. These findings suggest that appropriate anticoagulation therapy should be performed in patients with Takotsubo cardiomyopathy until wall motion abnormalities improve. Images provided by Wataru Mitsuma, MD, Masahiro Ito, MD, Nobue Yagihara, MD, Shinpei Kimura, MD, Komei Tanaka, MD, Satoru Hirono, MD, Makoto Kodama, MD, Yoshifusa Aizawa, MD, from the Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Copyright © 2008 by the American College of Cardiology Foundation.
