Case:

The following case represents an uncommon form of Tako-Tsubo cardiomyopathy. This 36 year old female patient had a black medical history. After a stressful event she developed complaints and symptoms of acute heart failure. She was subsequently admitted to the cardiac care unit and treated with intravenous diuretics, oxygen and also required inotropic support. Her ECG showed ST elevations in the precordial leads and the laboratory findings  revealed a significant rise in troponin. The echocardiographic evaluation after stabilization showed the following:

Conventional echocardiography:

LV systolic function is severely depressed. LVEF was calculated at 20-25%. There is an unusual distribution of wall motion abnormalities. The apical segments seem to show some residual contractility, while the basal and midventricular segments are akinetic. A coronary angiography was performed which did not show any abnormalities. Based on these findings the diagnosis Tako-Tsubo cardiomyopathy was made.

Deformation imaging:

Deformation imaging shows longitudinal deformation characteristics fitting the observations by visual assessment. The apical segments have normal deformation properties (normal time to onset strain and no post-systolic shortening) and high-normal peak systolic values. The basal and mid-ventricular segments have the typical characteristics of this disease: no systolic shortening (or even some systolic stretching) and exaggerated post systolic shortening in all these segments (see the PSI color plot)

An MRI was performed. This did not show any delayed enhancement

Follow up findings:

At 3 months follow up, patient was free of complaints. The echocardiographic abnormalities normalized (LVEF 60%), while the longitudinal deformation still showed reduced peak systolic values in the basal segments. Whether this will show further improvements remains unknown.