Takotsubo Cardiomyopathy Complicated by Cardiac Tamponade

An 83-year-old woman with no significant medical history developed acute onset chest pain lasting for 1 hour. Electrocardiography performed by emergency responders showed transient 2-mm high-lateral ST elevations on electrocardiography (Figure 1), and she was brought to the emergency room. She was treated with unfractionated heparin (60-U/kg bolus followed by 12 U/kg/min infusion), the glycoprotein IIb/IIIa inhibitor eptifibatide (180-μg/kg bolus followed by 2-μg · kg−1 · min−1 infusion), and 300 mg of clopidogrel by mouth. She developed severe hypotension that required high-dose parenteral inotropic support and was transferred to the catheterization laboratory for emergency cardiac catheterization. Coronary angiography revealed only minor atherosclerotic disease in a small diagonal branch; left ventriculography demonstrated akinesis of the entire mid to apical portions of the left ventricle, consistent with the “apical ballooning” syndrome, or takotsubo cardiomyopathy (Figure …