Korean Circ J.  2011 Oct;41(10):615-617. 10.4070/kcj.2011.41.10.615.

A Case of Anorexia Nervosa Complicated With Strongly Suspected Stress-Induced Cardiomyopathy and Mural Thrombus

• Kim KH
• Youn HJ
• Lee WH
• Kim JS
• Kim JG
• Park HW
• Min J
• Kim GH
• Jung HO

• KMID: 2297922
• DOI: http://doi.org/10.4070/kcj.2011.41.10.615

Abstract

Stress-induced cardiomyopathy is a unique reversible cardiovascular disease precipitated by acute emotional or physical stress. It is associated with a high prevalence of chronic anxiety disorder that precedes the onset of cardiomyopathy, as well as comorbid cardiovascular risk factors that are similar to the ST segment elevation of myocardial infarction. A thirty-five-year-old woman suffering from anorexia nervosa visited our hospital complaining of severe general weakness. She was diagnosed with stress-induced cardiomyopathy and mural thrombus using a transthoracic echocardiogram. Therefore, she was given anticoagulation therapy and nutrition with immediate psychiatric interventions. After two weeks of treatment, the follow-up echocardiogram indicated a significant improvement of the left ventricular dysfunction and mural thrombus.

Keyword

Stress cardiomyopathy; Anorexia nervosa; Thrombosis

MeSH Terms

Anorexia
Anorexia Nervosa
Anxiety Disorders
Cardiomyopathies
Cardiovascular Diseases
Female
Follow-Up Studies
Humans
Myocardial Infarction
Prevalence
Risk Factors
Stress, Psychological
Takotsubo Cardiomyopathy
Thrombosis
Ventricular Dysfunction, Left

Figure

• 

  Fig. 1 Electrocardiogram on admission and follow-up. A: the electrocardiogram revealed significant QTc prolongation and T wave inversion in leads II, III, aVF and V1-V6 on admission day. It also showed pathologic Q wave in leads II, III, aVF and V1-V3. B: follow-up electrocardiogram revealed normal sinus rhythm with non-specific ST segment change on the 7th hospital day.

• 

  Fig. 2 Transthoracic echocardiogram on admission. A: the photograph demonstrates a large akinetic area around the apex during diastole with linear echogenic mural thrombus (arrow) surrounding septal apex. B: this photograph showed hypercontraction of the basal segments with reduction of ejection fraction to 36% during systole.

• 

  Fig. 3 Follow-up transthoracic echocardiogram. A: the previous akinetic left ventricular walls showed an improvement on the wall motion during diastole, and the mural thrombus decreased (arrow). B: during systole, the improvement of the systolic left ventricular function was noticed: ejection fraction increased to 59% and pericardial effusion increased.

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