Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome

Tako-Tsubo syndrome is characterized by ECG changes mimicking acute myocardial infarction, left ventricular wall motion abnormalities in the apical region with preserved function of base, and normal coronary arteries. We report the cases of two old women, presenting apical akinesis, basal hyperkinesis, severe systolic dysfunction and severe mitral regurgitation (MR). Doppler echocardiography showed a left ventricular outflow tract obstruction (LVOTO), systolic anterior motion (SAM) of the mitral valve anterior leaflet. The patients recovered and, early later, left ventricular ejection fraction was documented as normal at echocardiography. The contemporary presence of LVOTO, SAM and MR might explain worsening of heart failure or incidence of cardiogenic shock in some patients with Tako-Tsubo syndrome.