Medicina (B Aires). 2026;86(2):545-549.
ABSTRACT
Tako-tsubo syndrome (TTS) is an acute cardiomyopathy characterized by transient left ventricular dysfunction in the absence of significant obstructive coronary artery disease. Although usually self-limited, it may be complicated by heart failure, arrhythmias, and the formation of a pedunculated left ventricular thrombus (LVT), with the risk of systemic embolism. We present the case of a 77-year-old woman with no cardiovascular history who presented with precordial pain in the context of emotional stress. Echocardiography showed apical akinesia, reduced ejection fraction, and a large pedunculated LVT-all findings confirmed by cardiac magnetic resonance imaging (MRI). Coronary angiography showed no significant lesions, and the clinical picture was interpreted as TTS. Anticoagulation with sodium heparin and beta-blockers was initiated. She evolved with recovery of ventricular function and increased LVT mobility, prompting consideration of surgical thrombectomy; however, this was ruled out because, hours before the planned procedure, she experienced peripheral embolism in the lower limbs and a subsequent reduction in LVT size. Her subsequent course was favorable, with complete resolution of the LVT and recovery of ventricular function under anticoagulant treatment, as well as restoration of lower limb perfusion. This case highlights the role of serial echocardiography, the recovery phase as a critical period for embolization, and the need for individualized therapeutic decisions. TTS may be complicated by LVT and embolism even in anticoagulated patients, posing a clinical challenge in the absence of specific guidelines.
PMID:41961620