biventricular thrombosis in biventricular stress(takotsubo)-cardiomyopathy

Endo-ventricular thrombosis represents a possible clinical complication of stress(takotsubo)-cardiomyopathy (sc). depressed ventricular systolic ventricular function, localized left ventricular (lv) dyskinesis, but also an increased pro-thrombotic state induced by catecholamine surge facilitate the occurrence of endovascular thrombosis in sc. sc, however, also present as right ventricular (rv) dysfunction or even as biventricular ballooning. ventricular thrombosis therefore theoretically occur in either ventricles or both. we report the case of an 88-year old woman, with vascular dementia and depression, admitted for abdominal pain, diarrhea, and rectal bleeding. unexpectedly, electrocardiogram showed induced qt-prolongation with diffuse negative t-waves, while echocardiogram severe lv dysfunction (ejection fraction 35%), but also rv dysfunction and biventricular thrombosis. the diagnosis was therefore biventricular sc complicated by biventricular thrombosis; lv recovered after 10 days. when sc presents with a biventricular involvement, a careful assessment of either ventricular cavities should be therefore recommended to exclude the presence of (bi)ventricular thrombosis. it remains unresolved whether biventricular sc represent a condition at higher risk of ventricular thrombosis.