Takotsubo Cardiomyopathy Associated with Chronic Psychiatric Stress in Major Depressive Disorder in an Elderly Patient

Takotsubo cardiomyopathy (TC) is a transient form of acute heart failure that most often occurs in postmenopausal women, typically triggered by a preceding emotional or physical stressor. A 74-year-old woman who suffered from chronic psychiatric stress visited National Medical Center for dyspnea. Acute emotional or physical stress could not be identified despite careful history taking. An electrocardiogram showed diffuse T-wave inversions with prolonged QT interval, and the echocardiogram showed akinesia of mid and apical segments of the left ventricle with hyperkinesia at the base. There was no significant stenosis on coronary angiography. Differing from the typical case of TC, which follows acute stress triggers, our case indicates that underlying chronic psychiatric illness exacerbation can lead to TC. We suggest that cardiologists and psychiatrists be aware of this predisposition to TC, especially in the circumstances of acute heart failure.

A Case of Klippel-Trenaunay Syndrome with Acute Submassive Pulmonary Thromboembolism Treated with Thrombolytic Therapy

Klippel-Trenaunay syndrome is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous hemangiomas, soft tissue and bony hypertrophy of limb. Potential complications such as deep venous thrombosis and pulmonary thromboembolism have not been reported in Korea to date. We demonstrate the case of a 48-year-old woman with Klippel-Trenaunay syndrome with extensive varicose veins on right lower limb, hypertrophy of left big toe and basilar artery tip aneurysm, complicated with acute submassive pulmonary thromboembolism treated successfully with intravenous thrombolytic therapy.