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A Woman in Her 70s With Hypotension, Diffuse ST-Elevation, Murmurs, and an Intracardiac Mass

A previously healthy woman in her early 70s developed subacute exertional dyspnea and dizziness and was found to be hypotensive (blood pressure, 84/59 mm Hg) with a systolic murmur on examination. She had diffuse ST-segment elevation on electrocardiography and elevated troponin and brain natriuretic peptide levels. Echocardiography showed left ventricular (LV) wall-motion abnormalities involving the mid and apical segments and an LV apical mass with protruding features. Noncontrast computed tomography confirmed the LV mass. Coronary angiography revealed mild to moderate coronary atherosclerosis without obstructive coronary artery disease.

This cine cardiovascular magnetic resonance imaging video in the horizontal long-axis view shows apical ballooning with hyperkinesia of basal LV segments, an LV apical thrombus, and a systolic jet in LV outflow tract (LVOT), suggesting dynamic obstruction of the LVOT due to septal bulging and systolic anterior motion of the anterior mitral valve leaflet.

She was diagnosed with stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy). β-Blocker therapy improved her hemodynamics and anticoagulant therapy resolved her thrombus.

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