• Cemil Izgi, Sanjoy Ray, Evangelia Nyktari, Francisco Alpendurada, Alexander R Lyon, Sudhir Rathore, and Arun John Baksi.
• Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK.
• Heart Lung. 2015 Nov 1; 44 (6): 481-5.

AbstractMyocardial edema is one of the characteristic features in the pathogenesis of Takotsubo syndrome. We report a middle aged man who presented with typical clinical and echocardiographic features of apical variant of Takotsubo syndrome. However, a cardiovascular magnetic resonance study performed 10 days after presentation did not show any apical 'ballooning' but revealed features of an apical hypertrophic cardiomyopathy on cine images. Tissue characterization with T2 weighted images proved severe edema as the cause of significantly increased apical wall thickness. A follow-up cardiovascular magnetic resonance study was performed 5 months later which showed that edema, wall thickening and the appearance of apical hypertrophic cardiomyopathy all resolved, confirming Takotsubo syndrome as the cause of the initial appearance. As the affected myocardium most commonly involves the apical segments, an edema induced increase in apical wall thickness may lead to appearances of an apical hypertrophic cardiomyopathy rather than apical ballooning in the acute to subacute phase of Takotsubo syndrome. Copyright © 2015 Elsevier Inc. All rights reserved.

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