Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:625 - Vol. 68 Num.07 DOI: 10.1016/j.rec.2014.08.013

Histological Findings in Tako-tsubo Syndrome

Isaac Pascual a,, Ana Isabel Abó b, Manel Piqué a

a Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lleida, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Arnau de Vilanova, Lleida, Spain

Article

A 75-year-old woman with Child B primary biliary cirrhosis under treatment with ursodeoxycholic acid was hospitalized for edematous ascitic decompensation related with spontaneous bacterial peritonitis, which was treated with intravenous ciprofloxacin. On the third day, she had an onset of anginal pain, anterior wall ST-segment elevation, and cardiogenic shock.

Urgent catheterization showed an absence of significant coronary lesions (Figure 1) and severely depressed systolic function, with medial and apical dyskinesia of the anterior and inferior walls, and hypercontractility of the basal segments (Figure 1), consistent with tako-tsubo syndrome. The patient received inotropic support and underwent implantation of a counterpulsation balloon, but she died at 12 hours due to multiorgan dysfunction and consumption coagulopathy.

Figure 1.

The post mortem macroscopic study showed an absence of structural changes (Figure 2). Microscopy revealed contraction bands in the myocardial fibers (Figure 2, black arrows) and diffuse infiltration of polymorphonuclear leukocytes (Figure 2, white arrows) throughout the left ventricle.

Figure 2.

The pathological findings of endomyocardial biopsies described in tako-tsubo syndrome include interstitial infiltrates of lymphocytes, leukocytes and macrophages, myocardial fibrosis, and contraction bands, with or without myocyte necrosis. The inflammatory changes and contraction bands differentiate tako-tsubo syndrome from the coagulation necrosis occurring in acute myocardial infarction. This is a singular case because postmortem study enabled examination of the entire heart, which confirmed that the reported microscopic findings are diffusely present in all the left ventricular territories.

Corresponding author: ipascua@live.com

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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