Table 1: Reported cases with cardiac rupture in takotsubo cardiomyopathy patients (Ovid MEDLINE, 2018).

AuthorsAge (in years)GenderClinical presentationEKG findingTroponin (ng/ml)ECHO findingsCatheterization findingsOutcomesAutopsy findings

Kumar et al. [9]62FemaleWeakness and lightheadednessST elevation in I, II, and V5-V611.64EF 30% and severely reduced LV systolic function in mid and distal segments and preserved at basal segmentsNonstentable 50-75% stenosis at mid LAD arteryDeathSlit-like rupture at the mid portion of the posterior ventricular wall
Zalewska-Adamiec et al. [11]74FemaleChest painSinus rhythm with QS complex and ST segment elevation in V2-V62.041Contractile disturbances in the apex and hyperkinesis of basal segments with EF 56% and cardiac tamponadeNo significant stenosisSurgical repair and good condition on dischargeNot applicable
Kudaiberdiev et al. [12]63FemaleChest pain, lightheadedness, dyspneaQ waves in III and aVF, T wave inversions in lead II, III, and aVF, and ST-T abnormalities in V5-V60.0LV dilatation EF (35%) moderate MR, hypoakinesia and thinning of LV inferolateral wall with rupture and cross-over blood shunt through two defects into the pericardiumPatent coronary arteriesSurgical repair and good condition on dischargeNot applicable
Sung et al. [13]73FemaleChest pain and dyspneaST elevation in V2-V51.3Akinesis of mid to apical left ventricle with EF of 58%Patent coronary arteriesDeathNot performed
Yoshida et al. [5]78FemaleChest pain and dyspneaRBBB and ST elevation in V2-V6 with QS patternNot mentionedApical kinesis with wall thinning and massive pericardial effusionPatent coronary arteriesIn good condition after dischargeNot applicable
Indorato et al. [1]70FemaleChest pain and nauseaNot doneNot doneNot performedNot performedDeath. Patient died en route to hospitalHemorrhagic infarction of LV apex. 0.4 cm line of ruptured myocardium from anterior to posterior wall at the apex
Shams [14]73MaleClinical features of pulmonary edemaSinus tachycardia with Q waves and ST elevation in inferior leads and depression in anterolateral leads2.840Left ventriculography: akinesis in the middle and basal-inferior wall and in broad band of mid anterior, mid lateral, and mid septal parts of the left ventricle and hemopericardium. Bedside, limited echo shows cardiac tamponadeStenosis of all three major arteries. No signs of coronary occlusionDeathHemopericardium, perforation of LV free wall at upper posterior part
Kurisu and Inoue [2]81FemaleUnconsciousnessST segment elevation in I, II, III, aVF, and V2-V6Not mentionedApical akinesia and basal hyperkinesisPatent coronary arteriesDeathNot performed
Sacha et al. [6]81FemaleChest painDiffuse ST elevation in the precordial and limb leads1.55Balloon-like LV motion abnormalities with akinesis from mid to apical portions and hyperkinesis of baseNo coronary artery diseaseDeathHemopericardium with an LV free wall rupture measuring 10 mm in the apical region and no patent coronary arteries. Inside the heart, there was a mural thrombus in the apical area
Jaguszewski et al. [15]82FemaleChest painSt segment elevation from V1 to V514.82Abnormal LV contraction with apical ballooning pattern with EF of 55%Patent coronary arteriesDeathWide penetrating apical rupture as well as 1500 ml of thrombi and liquid blood in the pericardium
Shinozaki et al. [16]90FemaleChest painST segment elevation in aVL and V1-V4Not mentionedLV apical akinesis and hyperkinesis of baseIntact coronary arteriesDeathNot mentioned
Akashi et al. [8]70FemaleChest discomfortST elevation in I, II, III, aVL, aVF, and V2-V6Not mentionedApical akinesis and basal hyperkinesis with EF of 51%Normal coronary arteriesDeathNot performed
Showkathali et al. [17]86FemaleChest painST segment elevation in anterolateral and inferior leadsNot mentionedShows TCM and no intraventricular gradientNormal RCA and mild atheromatous LAD arteryDeathNot mentioned
Yamada et al. [18]71FemaleShoulder and back painSt segment elevation in leads V4-V6 and abnormal Q waves in leads V4-V5Not mentionedLeft ventricular apical wall akinesis. Hyperkinesis in the basal wall with mitral valve systolic anterior wall motionNo coronary artery stenosisDeathNot performed
Stöllberger et al. [19]71FemaleGeneralized tonic clonic seizureST segment elevation in II, II, avF, V5, and V6Trop-T positiveLeft ventricular apical wall, apical septum, and apical posterior wall akinesia and small pericardial effusionNormal coronary arteriesDeath5 mm left ventricular rupture in the apicoposterior region
Ohara et al. [20]79FemaleChest painST segment elevation in 1, aVL, and V1-V5; depression in leads III and avF; and abnormal Q wave in V1-V4Not mentionedAkinesis of the left ventricular apical wallPatent coronary arteriesDeathRupture in the anterior portion of the left ventricle, patent coronary arteries, and hemopericardium
Mafrici et al. [21]87FemaleChest pain and dyspneaST segment elevation in inferior leads and V2-V6Trop-T: 20Apical dyskinesis with hyperkinesis of left ventricular basal segmentPatent coronary arteriesDeathNot performed
Ishida et al. [22]67FemaleChest painST segment elevation in I, avL, and V2-V5Not mentionedApical ballooning, basal hyperkinesis, and left ventricular outflow pressure gradient of 110 mmHg associated with systolic anterior movement of anterior mitral leafletExtensive akinesis from the apex to mid portionSurgical repair to correct the cardiac rupture slitNot applicable
Leva et al. [23]65FemaleChest pain and dyspneaST segment elevation in anterior leadsNot mentionedAkinesis from mid to apical LV and basal hyperkinesis, EF of 30%No significant stenosis of epicardial coronary arteriesDeathNot mentioned
Iskander et al. [24]77FemaleUnconsciousness, chest pain, and dyspneaST segment. Elevation in leads I, aVL, and V2-V6Trop-T: 3.60EF of 25%. Severe dyskinesis of anterolateral wall of LV, no LVOT obstructionNo coronary artery obstruction with slow flow down the LADDeathFresh clot on epicardial surface, slit-like rupture on anteroapical surface of LV
Present case75FemaleChest pain and dyspneaSinus rhythm, no ST segment elevation, poor R wave progression6.80EF of 30-35%, severe hypokinesis of apical LV, and asymmetric hypertrophy of the basal septumNot performedDeathHemopericardium, patent epicardial coronary arteries, slit-like rupture of the anterior wall of LV

Abbreviations: LV: left ventricle; LAD: left anterior descending artery; RCA: right coronary artery; EF: ejection fraction; TCM, takotsubo cardiomyopathy; LVOT: left ventricular outflow tract obstruction; LAD: left anterior descending artery.