Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Herath, H. M. M. T. B.; Pahalagamage, S. P.; Lindsay, Laura C.; Vinothan, S.; Withanawasam, Sampath; Senarathne, Vajira; Withana, Milinda

doi:10.1186/s12872-017-0616-0

Table 1 Case report review of takotsubo cardiomyopathy complicated with ventricular thrombus formation from 2003 to 2017

From: Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Year	Age (Years)	Gender	Day of diagnosis^a	Site of the thrombus	Treatment^b	Time for resolution^c	Ejection Fraction %	Thrombo Embolism^d	Reference
2003	74	F	4	4 × 4 mm, LV apex	Warfarin	2w		Right hemiparesis	[6]
2003	64	F	2	LV	Anticoagulation	12w	40		[7]
2004	76	F	6		Heparin and warfarin	2w			[35]
2004	57	F	2	LV apex, 2.0 × 1.5 cm	Heparin and warfarin	4w		Right upper limb hemiplegia	[36]
2004	44	F	11 weeks	LV apex	Urokinase, warfarin			Renal infarct	[17]
2006	64	F		LV apex, 13 × 8 mm	Anticoagulant	4w			[37]
2006	76	F		LV apex	Anticoagulant	3w	35		[38]
2007	54	F	2	LV apex	Heparin and warfarin	1w			[15]
2007	74	F	3	LV apex	Heparin and warfarin	12d	33		[39]
2007	70	F	3	LV apex	Anticoagulant	3 m		Sensory aphasia	[40]
2007	74	M	14	20 × 15 mm LV apex	Anticoagulant	7w	30		[10]
2007	74	F		LV apex	Anticoagulant	2 m	40		[41]
2008	69	F	1	LV apex, Two mobile thrombi 5 × 6 mm and 8 × 10 mm	Heparin and phenprocoumon	4w	39		[8]
2008	69	F	8	Mobile thrombus adjacent to the posteromedial papillary muscle	Heparin	9d	30		[8]
2008	43	F	4	LV apex	Heparin	11d	34		[8]
2008	69	F	3	28 × 22 mm anterior and anteroseptal wall, 4 × 4 mm mobile thrombus adjacent to the anterolateral papillary muscle	Heparin	27d	45		[8]
2008	55	F	2	LV apex	Heparin and warfarin	1 m			[19]
2008	53	F		LV apex	Heparin aspirin	2w	32		[42]
2008	74	F		Multiple thrombotic masses	Warfarin	2w	35	Dysphasia, right arm paresis	[26]
2008	43	F	5	LV apex	Heparin and warfarin	8d	<25	Right renal infarct	[43]
2008	64	F		LV apex	Warfarin		45	Broca’s aphasia	[44]
2009	28	F	3	LV apex	Heparin and warfarin	3w	25		[20]
2009	57	M		LV apex	Heparin and warfarin	2w	48		[45]
2011	78 87 71 82 55	F F F F F		Mural in 2 cases and protruding in 3 cases	Anticoagulant	4w	45 ± 6%	Cerebral infarction in one patient	[4]
2011	62	F	35	LV apex	Heparin and warfarin	3 m	18		[16]
2011	76	F	8	LV apex, 24 × 25 mm	Heparin and warfarin	1w	18	Multiple brain embolic infarctions	[46]
2011	68	F	3	LV apex, 26 × 29 mm	Heparin and warfarin	12d			[47]
2011	69	F	6	LV apex	Anticoagulant	14d			[48]
2012	78	F		LV apex	Anticoagulant	2w	50		[49]
2012	70	F	13	LV apex	Anticoagulant		55		[50]
2012	29	F	2	Mid right ventricular cavity, 16 × 9 8 mm,	Anticoagulant	7d			[22]
2012	48	M	15	Apical inferior wall, 28 × 16 mm	Sx				[25]
2012	78	F	7	LV apex	Heparin	17d			[30]
2013	52	F	3	LV apex, 37 × 21 mm	Heparin and warfarin			Multifocal micro infarctions in the brain, pleen and kidneys	[27]
2013	78	F		Attached to septoapical wall, 30 × 15 mm	Aspirin, heparin		35	Left hemiparesis and dysarthria, large thrombus at the trunk and branches of the superior mesenteric artery	[24]
2013	50	M		LV apex, 3.6 cm × 1.7 cm	Enoxaparin, Clopidogrel and warfarin	7w	45	Dense left sided hemiplegia, left homonymous hemianopia, aphasia	[31]
2013	63	F	3 weeks	LV apex, 1.10 × 2.12 cm	Heparin and warfarin	3 m	43		[18]
2013	58	F	2		Heparin, warfarin and sx				[33]
2015	66	F		LV apex	Heparin, acetyl-salicylic acid and clopidogrel	17d		Ischemic infarctions of the left median cerebral artery	[51]
2015	59	F	13	LV apex	Heparin, Warfarin, sx		<25		[21]
2016	48	F		LV apex	Anticoagulant	3 m		Right femoral artery embolism	[52]
2016	57	F	4	LV apex, 2.3 × 3.3 cm	Warfarin	15d	35		[53]
2016	61	F		LV apex	Heparin and warfarin		35		[14]
2016	55	F		LV apex, 20 × 10 mm	Warfarin	3 m			[54]
2017	48	F		LV apex	Heparin and warfarin		30		[55]
2017	88	F		Biventricular	Heparin		35		[21]
2003	74	F	4	4 × 4 mm, LV apex	Warfarin	2w		Right hemiparesis	[6]
2003	64	F	2	LV	Anticoagulation	12w	40		[7]
2004	76	F	6		Heparin and warfarin	2w			[35]
2004	57	F	2	LV apex, 2.0 × 1.5 cm	Heparin and warfarin	4w		Right upper limb hemiplegia	[36]
2004	44	F	11 weeks	LV apex	Urokinase, warfarin			Renal infarct	[17]
2006	64	F		LV apex, 13 × 8 mm	Anticoagulant	4w			[37]
2006	76	F		LV apex	Anticoagulant	3w	35		[38]
2007	54	F	2	LV apex	Heparin and warfarin	1w			[15]
2007	74	F	3	LV apex	Heparin and warfarin	12d	33		[39]
2007	70	F	3	LV apex	Anticoagulant	3 m		Sensory aphasia	[40]
2007	74	M	14	20 × 15 mm LV apex	Anticoagulant	7w	30		[10]
2007	74	F		LV apex	Anticoagulant	2 m	40		[41]
2008	69	F	1	LV apex, Two mobile thrombi 5 × 6 mm and 8 × 10 mm	Heparin and phenprocoumon	4w	39		[8]
2008	69	F	8	Mobile thrombus adjacent to the posteromedial papillary muscle	Heparin	9d	30		[8]
2008	43	F	4	LV apex	Heparin	11d	34		[8]
2008	69	F	3	28 × 22 mm anterior and anteroseptal wall, 4 × 4 mm mobile thrombus adjacent to the anterolateral papillary muscle	Heparin	27d	45		[8]
2008	55	F	2	LV apex	Heparin and warfarin	1 m			[19]
2008	53	F		LV apex	Heparin aspirin	2w	32		[42]
2008	74	F		Multiple thrombotic masses	Warfarin	2w	35	Dysphasia, right arm paresis	[26]
2008	43	F	5	LV apex	Heparin and warfarin	8d	<25	Right renal infarct	[43]
2008	64	F		LV apex	Warfarin		45	Broca’s aphasia	[44]
2009	28	F	3	LV apex	Heparin and warfarin	3w	25		[20]
2009	57	M		LV apex	Heparin and warfarin	2w	48		[45]
2011	78 87 71 82 55	F F F F F		Mural in 2 cases and protruding in 3 cases	Anticoagulant	4w	45 ± 6%	Cerebral infarction in one patient	[4]
2011	62	F	35	LV apex	Heparin and warfarin	3 m	18		[16]
2011	76	F	8	LV apex, 24 × 25 mm	Heparin and warfarin	1w	18	Multiple brain embolic infarctions	[46]
2011	68	F	3	LV apex, 26 × 29 mm	Heparin and warfarin	12d			[47]
2011	69	F	6	LV apex	Anticoagulant	14d			[48]
2012	78	F		LV apex	Anticoagulant	2w	50		[49]
2012	70	F	13	LV apex	Anticoagulant		55		[50]
2012	29	F	2	Mid right ventricular cavity, 16 × 9 8 mm,	Anticoagulant	7d			[22]
2012	48	M	15	Apical inferior wall, 28 × 16 mm	Sx				[25]
2012	78	F	7	LV apex	Heparin	17d			[30]
2013	52	F	3	LV apex, 37 × 21 mm	Heparin and warfarin			Multifocal micro infarctions in the brain, spleen and kidneys	[27]
2013	78	F		Attached to septoapical wall, 30 × 15 mm	Aspirin, heparin		35	Left hemiparesis and dysarthria, large thrombus at the trunk and branches of the superior mesenteric artery	[24]
2013	50	M		LV apex, 3.6 cm × 1.7 cm	Enoxaparin, Clopidogrel and warfarin	7w	45	Dense left sided hemiplegia, left homonymous hemianopia, aphasia	[31]
2013	63	F	3 weeks	LV apex, 1.10 × 2.12 cm	Heparin and warfarin	3 m	43		[18]
2013	58	F	2		Heparin, warfarin and sx				[33]
2015	66	F		LV apex	Heparin, acetyl-salicylic acid and clopidogrel	17d		Ischemic infarctions of the left median cerebral artery	[51]
2015	59	F	13	LV apex	Heparin, Warfarin, sx		<25		[21]
2016	48	F		LV apex	Anticoagulant	3 m		Right femoral artery embolism	[52]
2016	57	F	4	LV apex, 2.3 × 3.3 cm	Warfarin	15d	35		[53]
2016	61	F		LV apex	Heparin and warfarin		35		[14]
2016	55	F		LV apex, 20 × 10 mm	Warfarin	3 m			[54]
2017	48	F		LV apex	Heparin and warfarin		30		[55]
2017	88	F		Biventricular	Heparin		35		[21]
2003	74	F	4	4 × 4 mm, LV apex	Warfarin	2w		Right hemiparesis	[6]
2003	64	F	2	LV	Anticoagulation	12w	40		[7]
2004	76	F	6		Heparin and warfarin	2w			[34]
2004	57	F	2	LV apex, 2.0 × 1.5 cm	Heparin and warfarin	4w		Right upper limb hemiplegia	[35]
2004	44	F	11 weeks	LV apex	Urokinase, warfarin			Renal infarct	[17]
2006	64	F		LV apex, 13 × 8 mm	Anticoagulant	4w			[36]
2006	76	F		LV apex	Anticoagulant	3w	35		[37]
2007	54	F	2	LV apex	Heparin and warfarin	1w			[15]
2007	74	F	3	LV apex	Heparin and warfarin	12d	33		[38]
2007	70	F	3	LV apex	Anticoagulant	3 m		Sensory aphasia	[39]
2007	74	M	14	20 × 15 mm LV apex	Anticoagulant	7w	30		[10]
2007	74	F		LV apex	Anticoagulant	2 m	40		[40]
2008	69	F	1	LV apex, Two mobile thrombi 5 × 6 mm and 8 × 10 mm	Heparin and phenprocoumon	4w	39		[8]
2008	69	F	8	Mobile thrombus adjacent to the posteromedial papillary muscle	Heparin	9d	30		[8]
2008	43	F	4	LV apex	Heparin	11d	34		[8]
2008	69	F	3	28 × 22 mm anterior and anteroseptal wall, 4 × 4 mm mobile thrombus adjacent to the anterolateral papillary muscle	Heparin	27d	45		[8]
2008	55	F	2	LV apex	Heparin and warfarin	1 m			[19]
2008	53	F		LV apex	Heparin aspirin	2w	32		[41]
2008	74	F		Multiple thrombotic masses	Warfarin	2w	35	Dysphasia, right arm paresis	[24]
2008	43	F	5	LV apex	Heparin and warfarin	8d	<25	Right renal infarct	[42]
2008	64	F		LV apex	Warfarin		45	Broca’s aphasia	[43]
2009	28	F	3	LV apex	Heparin and warfarin	3w	25		[44]
2009	57	M		LV apex	Heparin and warfarin	2w	48		[45]
2011	78 87 71 82 55	F F F F F		Mural in 2 cases and protruding in 3 cases	Anticoagulant	4w	45 ± 6%	Cerebral infarction in one patient	[4]
2011	62	F	35	LV apex	Heparin and warfarin	3 m	18		[16]
2011	76	F	8	LV apex, 24 × 25 mm	Heparin and warfarin	1w	18	Multiple brain embolic infarctions	[46]
2011	68	F	3	LV apex, 26 × 29 mm	Heparin and warfarin	12d			[47]
2011	69	F	6	LV apex	Anticoagulant	14d			[48]
2012	78	F		LV apex	Anticoagulant	2w	50		[49]
2012	70	F	13	LV apex	Anticoagulant		55		[50]
2012	29	F	2	Mid right ventricular cavity, 16 × 9 8 mm,	Anticoagulant	7d			[20]
2012	48	M	15	Apical inferior wall, 28 × 16 mm	Sx				[23]
2012	78	F	7	LV apex	Heparin	17d			[28]
2013	52	F	3	LV apex, 37 × 21 mm	Heparin and warfarin			Multifocal micro infarctions in the brain, spleen and kidneys	[25]
2013	78	F		Attached to septoapical wall, 30 × 15 mm	Aspirin, heparin		35	Left hemiparesis and dysarthria, large thrombus at the trunk and branches of the superior mesenteric artery	[22]
2013	50	M		LV apex, 3.6 cm × 1.7 cm	Enoxaparin, Clopidogrel and warfarin	7w	45	Dense left sided hemiplegia, left homonymous hemianopia, aphasia	[29]
2013	63	F	3 weeks	LV apex, 1.10 × 2.12 cm	Heparin and warfarin	3 m	43		[18]
2013	58	F	2		Heparin, warfarin and sx				[31]
2015	66	F		LV apex	Heparin, acetyl-salicylic acid and clopidogrel	17d		Ischemic infarctions of the left median cerebral artery	[51]
2015	59	F	13	LV apex	Heparin, Warfarin, sx		<25		[32]
2016	48	F		LV apex	Anticoagulant	3 m		Right femoral artery embolism	[52]
2016	57	F	4	LV apex, 2.3 × 3.3 cm	Warfarin	15d	35		[53]
2016	61	F		LV apex	Heparin and warfarin		35		[14]
2016	55	F		LV apex, 20 × 10 mm	Warfarin	3 m			[54]
2017	48	F		LV apex	Heparin and warfarin		30		[55]
2017	88	F		Biventricular	Heparin		35		[21]

F female, M male,
Day of diagnosis^a = the date of diagnosis from the onset of symptoms / diagnosis of takotsubo cardiomyopathy, given in number of days, in 2 cases given in weeks
Treatment^b = anticoagulant = In case reports which has not specified the anticoagulant used, Sx = ventriculotomy and surgical thrombectomy
Time for resolution^c = d days, w weeks, m months
Thrombo Embolism^d = Thrombo embolic episodes diagnosed after the detection of ventricular thrombus

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