Clinical Management of Takotsubo Cardiomyopathy

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp stress such as asthma attack or non-cardiac surgery have been identified in previous cases. 3 These stressors are common events that anyone may experience. Men account for a minority of cases; reports range from 4% to 13%. 6-8 In men, physical stress rather than emotional stress is much more associated with the occurrence. 7,8 ElectrocardiographyCommon abnormalities on the initial ECG are ST-segment elevation, negative T wave and subsequent QT interval prolongation (Figure 2). 3-5,9-11 There is a significant variability in frequency because these ECG changes are time-dependent. 12, 13 The typical time course of the ECG is as follows. 12 ST-segment elevation usually occurs shortly after onset. Negative T wave deepens progressively to its first negative peak, which occurs at approximately 3 days. The negative T wave becomes shallow for several days and then deepens, the second negative peak occurring at approximately 2 weeks. QT interval becomes prolonged progressively as the negative T wave deepens. These ECG changes are found in takotsubo cardiomyopathy as well as AMI, and the differential diagnosis is clinically important for appropriate management. Ogura et al reported that the absence of reciprocal changes, the absence of abnormal Q wave and the sum of ST-segment elevation in leads V4-6 more than the sum of ST-segment elevation in leads V1-3 identified takotsubo cardiomyopathy with a high sensitivity and specificity. 14 Kosuge et al recently reported that the combination of ST-segment depression in lead aVR and no STsegment elevation in lead V1, or the combination of positive T wave in lead aVR and no negative T wave in lead aVR, was more useful in identifying takotsubo cardiomyopathy. 15,16 EchocardiographyEchocardiography plays a central role in the diagnosis of takotsubo cardiomyopathy. Typically, RWMA is found in the apical to mid segments of the left ventricle, extending beyond a single coronary territory. Relative compensatory hypercontractility is often found in the basal segment. Other patterns akotsubo cardiomyopathy is an acute cardiac syndrome mimicking acute myocardial infarction (AMI), and is characterized by chest symptoms, electrocardiographic (ECG) changes and reversible regional wall motion abnormality (RWMA) in the apical to mid segments of the left ventricle. 1-5 In contrast to AMI, takotsubo cardiomyopathy exhibits RWMA independent of acute plaque rupture or myocardial ischemia with coronary atherosclerosis during the early stage. RWMA occurs in the apical to mid segments of the left ventricle, extending beyond a single coronary territory (Figure 1), and it usually resolves spontaneously within a matter of days to a few weeks.Takotsubo cardiomyopathy was first reported by Sato et al at Hiroshima City Hospital in 1990, 1-3 since when it has become increasingly recognized worldwide. Several mechanisms, including multivessel coronary artery spasm, coronary microvascular dysfunction or catecholami...

Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review

“…5,14,27,28,[39][40][41][42][43] Although many patients recover without complications, about 50% experience some complications. 5 Serious complications are not uncommon and include congestive heart failure (12-45%), pulmonary edema (8 to [ 20%), and cardiogenic shock (4-20%).…”

Stress Related Takotsubo Cardiomyopathy: A Case Report

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Acute arterial occlusion due to left ventricular thrombus of Takotsubo cardiomyopathy in a young adult: a case report

“…Takotsubo cardiomyopathy was first reported in Japan in 1990 and has since become increasingly recognized worldwide [1]. This cardiomyopathy is normally described as apical ballooning due to apical akinesis or hypokinesis with preserved basal segments.…”