Takotsubo Cardiomyopathy

Recently came across two cases of Takotsubo syndrome. One of them diagnosed during angiography (normal with typical apical balloning. Here is synopsis of this cardiomyopathy, further reading can be done from various resources, however, one good site is http://www.takotsubo.com/

Essentials of Diagnosis
Occurs after a major catecholamine discharge.
Acute chest pain or shortness of breath.
Predominately affects postmenopausal women.
Presents as an acute anterior myocardial infarction, but coronaries normal at cardiac catheterization.
Imaging reveals apical left ventricular ballooning due to anteroapical stunning of the myocardium.

General Considerations
LV apical ballooning can follow a high catecholamine stress. The resulting shape of the LV suggests a rounded ampulla form similar to an octopus pot (takotsubo pot). The acute myocardial injury that occurs is more common in postmenopausal women. It has been described following some stressful event, such as hypoglycemia, lightning strikes, earthquakes, postventricular tachycardia, during alcohol withdrawal, following surgery, during hyperthyroidism, and following emotional stress.

Clinical Findings
Symptoms and Signs
The symptoms are similar to any acute coronary syndrome. Typical angina and dyspnea is usually present. Syncope is rare.

ECG and Chest Radiography
The ECG reveals ST segment elevation as well as deep anterior T wave inversion. The chest radiograph is either normal or reveals pulmonary congestion.

Diagnostic Studies
The echocardiogram reveals LV apical dyskinesia. The urgent cardiac catheterization reveals the LV apical ballooning in association with normal coronaries.



TreatmentImmediate therapy is similar to any acute myocardial infarction. Initiation of long-term therapy depends on whether LV dysfunction persists. Most patients receive aspirin, -blockers, and ACE-inhibitors until the LV fully recovers.

Prognosis
Prognosis is good unless there is a serious complication (such as mitral regurgitation, ventricular rupture, ventricular tachycardia). Recovery is expected in most cases after a period of weeks to months. At times, the LV function recovers in days.