Left ventricular free wall rupture in a Caucasian female with takotsubo syndrome: a case report and a brief literature review

The takotsubo syndrome is a clinical entity that can mimic an acute myocardial infarction. It is characterised by anginal chest pain with ST-T elevation in precordial leads, without coronary obstruction at angiography; its distinctive feature is a peculiar pattern of left ventricular contraction, with expansion of the apical segments and basal hyperkinesis, also known as 'apical ballooning'. This syndrome usually has a good prognosis, with normalisation of the left ventricular contraction impairment within several days, although Japanese authors have described two cases of free left ventricular wall rupture in these patients. We describe a case of apical ballooning syndrome complicated by left ventricular rupture in a Caucasian old female. To our knowledge, this is the first-ever case of a fatal outcome in the Caucasian population, due to free wall ventricular rupture, and confirms that the takotsubo syndrome may lead to a fatal cardiac event.