Evidence of Myocardial Edema in Obstructive Tako-tsubo Cardiomyopathy Complicated by Cardiogenic Shock

The contemporary presence of left ventricular (LV) outflow tract obstruction, systolic anterior motion of the anterior mitral leaflet, and acute mitral regurgitation may occur in Tako-tsubo cardiomyopathy. Although myocardial edema has been reported in patients with Tako-tsubo cardiomyopathy, to the best of our knowledge it has never been described in the setting of LV outflow obstruction and the presence of cardiogenic shock. We report the case of a 65-year-old woman who developed Tako-tsubo cardiomyopathy followed by acute cardiogenic shock. The echo-Doppler assessment revealed LV apical ballooning, moderate-to-severe mitral regurgitation, and an estimated peak systolic pressure gradient at LV outflow tract of 64 mmHg. The LV outflow obstruction and mitral regurgitation resolved shortly after the intravenous administration of atenolol (1.25 mg). The cardiogenic shock was completely resolved following the infusion of low-dose dobutamine: 2 γ/kg/min. In the following days, an echo-Doppler examination revealed a marked reduction in the thickness of the LV proximal hypertrophied septum (from 20 mm to 14 mm), while a cardiac magnetic resonance imaging study showed signs of mild edema of the mid-ventricular and apical septum