Takotsubo cardiomyopathy

Takotsubo cardiomyopathy is a cardiac dysfunction characterized by transient segmented ballooning of the left ventricle, usually the apical region. It mainly affects postmenopausal women and represents 1 to 2% of all cases of suspected myocardial infarction. Clinical presentation is similar to that of an acute coronary syndrome, with chest pain and dyspnea as the main symptoms. Cardiac biomarkers and ECG are unable to differentiate Takotsubo from myocardial infarction. The diagnosis is suggested by the coexistence ofabnormal regional left ventricle kinetics, often severe, together with the absence of significant coronary disease. MRI imaging may be useful to confirm the diagnosis. Management mainly focuses on stabilising the patient's hemodynamics during the acute phase. Prognosis is usually excellent, and complete recovery of cardiac function is the norm. We report five cases of Takotsubo cardiomyopathy recently seen in our institution and review the literature.     

Takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular apical wall motion abnormalities, chest pain with electrocardiographic changes, and modest myocardial enzymatic release mimicking acute coronary syndrome, but without significant coronary artery disease. TC is an increasingly recognized type of acquired cardiomyopathy occurring commonly after a recent stressful event, in particular emotional stress, and is relatively common in middle-aged and older women. The pathogenetic mechanism remains unknown. Catecholamine surge related to emotional distress seems to play a major role in the pathogenesis of this cardiomyopathy, rendering TC a type of neurocardiological disorder that manifests as acute but reversible heart failure. Clinicians should consider this syndrome in the differential diagnosis of patients presenting with clinical findings suggestive of acute coronary syndrome, especially in postmenopausal women with a recent history of acute emotional or physical stress.     

Takotsubo cardiomyopathy

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a clinical entity first described in the early 1990s in Japan and now receiving increased attention in the United States. The clinical features include an onset of chest pain mimicking that of an acute myocardial infarction, electrocardiogram changes similar to those of an acute myocardial infarction, normal coronary arteries on cardiac catheterization, and a signature appearance on echocardiogram. Takotsubo cardiomyopathy results in a significantly decreased ejection fraction that, as long as the patient receives appropriate hemodynamic support, typically undergoes spontaneous reversal. This article describes the history, clinical presentation, and management strategies for Takotsubo cardiomyopathy and provides a case study.     

Tirofiban in Takotsubo cardiomyopathy

Takotsubo cardiomyopathy, also known as broken heart syndrome, is similar to acute coronary syndrome. The absence of significant stenosis on coronary angiography and spontaneous improvement of ventricular akinesia are very important features that distinguish this syndrome from acute coronary syndromes. Despite the fact that ST segment elevations are typically encountered, atypical presentation without ECG changes should be kept in mind. We herein report the case of a 61-year-old woman who presented with mid-apical left ventricular akinesia resolving within 24 h.     

Takotsubo cardiomyopathy in siblings

We report the case of apical ballooning syndrome (ABS) in a female sibling. A 64-year-old woman was admitted to our hospital with sudden-onset chest pain. Cardiac enzymes were mildly elevated and an electrocardiogram showed broad ST-T changes. Emergency coronary angiography revealed no culprit lesion and left ventriculography demonstrated focal akinesis of the apical wall, which was consistent with ABS. Myocardial functional sympathetic innervations assessed using [¹²³I]metaiodobenzylguanidine was severely impaired in the apical region. Her clinical symptoms and cardiac dysfunction recovered spontaneously. Just 1 year prior to our patient’s cardiac event, her elder sister had the same symptoms and was also diagnosed with ABS. Both sisters were postmenopausal. The familial case of ABS is exceedingly rare, but these cases suggest a possible genetic etiology.     

Takotsubo cardiomyopathy in a patient with pulmonary embolism

Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient regional wall motion abnormalities of the left ventricular apex or midventricle. Patients often present with chest pain or dyspnoea, ST-segment elevation, and minor elevations of cardiac enzyme levels. Takotsubo cardiomyopathy has been associated with severe emotional or physical stress such as severe burns, spinal cord injury, subarachnoid haemorrhage, and multiple traumas. We report a case of takotsubo cardiomyopathy in a 79-year-old woman with pulmonary embolism. Although pulmonary embolism has been listed as a potential cause of takotsubo cardiomyopathy, this is the first case reported with this association.     

Transient mid-ventricular ballooning cardiomyopathy: a new entity of Takotsubo cardiomyopathy

We present a case of a 64-year-old man with transient mid-ventricular ballooning cardiomyopathy. Left ventriculography showed morphological differences with ballooning around the whole mid-portion of the left ventricle, although precipitating factors and clinical courses were similar to Takotsubo cardiomyopathy. We suspect that transient mid-ventricular ballooning cardiomyopathy is a new pathological entity in Takotsubo cardiomyopathy.