A type of anteroseptal left ventricular ballooning in a patient with Takotsubo cardiomyopathy

A 62-year-old man presented to our hospital with chest pain. The electrocardiogram revealed ST-segment elevation in leads V1 through V3. The transthoracic echocardiogram showed akinesia of the anteroseptal wall (Fig. 1a). The coronary angiogram (Fig. 1b, c) revealed no significant stenosis or occlusion in the coronary artery. However, the left ventriculogram showed severe hypokinesis of the midleft ventricle, while the basal left ventricle and left ventricular apex were hyperkinetic (Fig. 1d, e). The thallium-201 scintigram (Fig. 1f, left upper and lower images) and iodine-123-labeled 15-(p-iodophenyl)-3-R0S-methylpentadecanoic acid (BMIPP) (Fig. 1f, right upper and lower images) showed myocardial ischaemia in the anteroseptal wall, regardless of normal coronary blood flow. We diagnosed him