A case of Takotsubo cardiomyopathy showing two modes of initiation for ventricular fibrillation: Augmented J-wave and torsade de pointes with QT prolongation

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Presentation transcript:

A case of Takotsubo cardiomyopathy showing two modes of initiation for ventricular fibrillation: Augmented J-wave and torsade de pointes with QT prolongation Masato Shimizu, MD, PhD, Mitsuhiro Nishizaki, MD, PhD, Noriyoshi Yamawake, MD, PhD, Hiroyuki Fujii, MD, Harumizu Sakudara, MD, PhD, Masayasu Hiraoka, MD, PhD, FHRS HeartRhythm Case Reports Volume 2, Issue 5, Pages 436-440 (September 2016) DOI: 10.1016/j.hrcr.2016.07.001 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Left ventriculography (diastolic and systolic phases) exhibited akinesis of apical wall and hyperkinesis of basal wall. Angiography of the left coronary artery (LCA) and right coronary artery (RCA) showed no significant stenotic lesion. LAO = left anterior oblique; RAO caud = right anterior oblique and caudal angulation. HeartRhythm Case Reports 2016 2, 436-440DOI: (10.1016/j.hrcr.2016.07.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 The time sequence of changes in electrocardiogram (ECG) records of leads V4–V6. (A) ECG recorded at 2 years before patient’s admission. No J-wave is visible. (B) ECG recorded on admission to coronary care unit (CCU) without J-wave. (C) Left image shows ECG recorded after 16 hours of her admission. Arrows show prominent J waves. The QT interval is prolonged. Right image presents ECG records after 72 hours of admission. Asterisks indicate disappearance of J-waves. QT interval is nearly normalized. VF = ventricular fibrillation. HeartRhythm Case Reports 2016 2, 436-440DOI: (10.1016/j.hrcr.2016.07.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Two modes of ventricular fibrillation (VF) initiation. (A) Successive accentuation of J-wave amplitudes (arrows) followed by the initiation of VF. (B) Short-long-short sequence by premature atrial contraction causing prolonged QT interval and the initiation of torsade de pointes that degenerated into VF. Dashed line indicates a short beat-by-beat interval. Thick line indicates a long beat-by-beat interval. HeartRhythm Case Reports 2016 2, 436-440DOI: (10.1016/j.hrcr.2016.07.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions